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Living with Autism

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January 22, 2016

Treatment of Lactic Acidosis in Autistic Patients

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"High lactate levels are reported in about 1 in 5 children [teens and adults] with Autism Spectrum Disorder.."

Emergency room physicians should therefore check for elevated levels of lactic acid in autistic patients having an acute behavioral emergency.



"Children with Autism Spectrum Disorder (ASD) are NINE times more likely to visit an ER for "psychiatric problems" than children who don't have autism...Disruptive behavior...hurting oneself...are the main reasons for such visits in children, teens or adults with autism. "

"A significant percentage of children with autism present with metabolic abnormalities (e.g., high lactate levels) and other biochemical disturbances."

In one study, autistic patients were described as having two coexistent syndromes: Autism and behavioral disturbances, rooted in biochemical syndrome of lactic acidosis. 

Sadly, children, teens and adults with autism are often overmedicated on high doses of Ativan, seizure inducing antipsychotics or/and Versed, in the absence of medical testing for elevated lactic acid or other underlying medical issues causing disruptive behaviors. Understandably, an ER doc is mostly unfamiliar with autistic patients. And may even think lactic acidosis is no big deal, but it's a huge deal for someone with autism and extreme sensory issues.

If elevated lactic acid is found in a person with autism, what is the fastest, most effective treatment?

The most effective treatment might be a "banana bag" or plain IV hydration. Releasing an autistic person with elevated levels of lactic acidosis is only going to send them home with the same behavior that brought them to the ER. You can't simply wait this out. It entail immediate medical management to mitigate the discomfort that is causing the autistic patient great distress and pain.

Lactic acid is uncomfortable. For the non autistic person, you can work through it, so it's hard for you to relate to how they perceive this medical condition.

To an autistic person, elevated levels of lactic acid may feel as if there entire body is on fire.

How else can this be treated?

According to one study, after administration of 300 mg of intravenous Thiamine (B1), hyperlactatemia (lactic acidosis), normalized rapidly. How great is that? This is what you want for the autistic patient. 

If Lactic Acidosis is NOT normalized rapidly, you will be looking at slamming this patient with a copious amount of VERSED or ATIVAN, putting on restraints and creating a hot mess in the ER. 

Naturally, there are times you must place the autistic patient in restraints to get IV Thiamine flowing. 

And sure, even push a little Ativan, but please, don't just send the autistic patient home or not treat them. 

Patients with autism have complex sensory issues. They are vulnerable to the slightest discomforts. These discomforts escalate behaviors. 

Even more challenging, some autistic patients may present calmly  when they have a broken finger. Or laceration. But for some reason, lactic acidosis is a common antecedent to extreme increases in aberrant behavior. 

So how do you know what to do?

 The bottom line is judge the acute situation by lab results 

Specifically, an increased BEHAVIORAL response of the autistic person with elevated Lactic Acidosis. 

If they are going nuts in the ER and appear in pain, they are trying to tell you they are in pain and need help. 

Morphine, a typical opiate given to autistic patients in pain, isn't going to quickly clear the offending state of elevated lactate. 

The good news is research shows IV Thiamine can rapidly normalize lactic acid. 

Hence, the faster you can decrease lactate, the faster you'll get the autistic patient back to baseline and bring comfort and peace to all involved. 

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3145262/

Source: http://emedicine.medscape.com/article/768159-overview#a5