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High Levels of Lactic Acid

  I am looking for any information I can find regarding Critical levels of Lactic Acid.  Standard Ref Range 0.5 - 2.2; mine are 12.5.  Muscle biopsies for mitochondrial disorder have been performed with negative results.  I am constantly sore and in pain, and would like to konw if there is anything I can do to relieve my symptoms, and take to lower this level?  What type of specialist should I see? And ideas on cause or way to proceed, considering Neurology has their palms up, so does dermatology (re- a non specific rash I've had for over a year) and other Dr.s I have seen.  I am willing to listen to any ideas! :o) thanks
Dear Tim:
Usually high levels of lactic acid are a sign of a metabolic disorder.  One of the most common that we as neurologist would see would be a mitochondrial disorder.  To properly diagnose a mitochondrial disorder, it really takes multiple assays on different body fluids and may even need a muscle biopsy to be performed.  I am assuming that the electron transport chain was completely normal from a fresh biopsy, and that your amino acids and organic acids from both the serum and urine were normal, the acylcarnitines and free carnitines from serum and urine were normal.  I am also assuming that the lactic acid was properly drawn (that is without stopping the flow by using a turnique).  
If you have a high lactic acid level on muliple draws, then I am also assuming the your neurologist did an ischemic forearm test that evaluated ammonia, lactic acid and pyruvate.  Did you have an elevated CPK?  Assuming the above, then I would search for other metabolic causes of lactic acid such as metabolic disorders of TCA cycle, B-oxidation, etc.  If you have no symptoms then I would wait until your having symptoms and revisit some of the laboratory tests.  Without knowing what sort of symptoms your having, it is impossible to tell you what to look for with an isolated lactic acid level.  
CCF Neuro[P] MD

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