Dear Parent,
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Atrial septal defect is a defect in the inter atrial septum, the wall that separates the two atrial chambers inside the heart. It is a very common congenital heart defect in children. Even many adults have small asymptomatic ASDs. The size and type of the ASD determines the severity of the disease and hence, I would like to know these details, if available.
Lactic acid levels in the blood are a surrogate marker of tissue perfusion (effective blood to the organs). Normal levels are considered to be less than 2. When it is more than two, it is assumed that the blood is not effectively perfusing the organs of the body and hence tissues are resorting to anaerobic metabolism and producing more lactic acid. Serial lactate levels are more useful than single point assessments. Hence, it would be important to repeatedly test lactate levels and analyse the trends. Elevated lactate levels could also be due to underlying heart disease.
Inshort, this elevated lactic acid level is only a guideline investigation. It alone does not point towards a single condition.
Hope this helps
Please feel free to ask followup questions.
Patient replied :
asd Autism spectrum disorders, sorry I should of said she also has hypermobility my Daughter doesn't have any other heath issues.
Dear Parent,
Autism Spectrum Disorder and hyper mobility could be manifestation of an underlying metabolic disease or could be idiopathic. In absence of a heart disease, High levels of lactic acid can be a sign of a metabolic disorder. One of the most common that we as Pediatricians would see would be a mitochondrial disorder. Mitochondrial disorders could present with a variety of neurological manifestations. I am assuming that the blood sample for lactic acid estimation was properly drawn (that is without stopping the flow by using a tourniquet). Kindly get your child evaluated in detail by a pediatric neurologist. We need to get Arterial lactate, ammonia levels and a blood gas analysis. She needs to be evaluated for mitochondrial disorders if her ASD/ hyperactivity is significantly impairing. If she is an otherwise healthy child we could wait before proceeding with further testing.
Lactic acidosis has also been described in children with significant hyperactivity due to muscle overuse. It needs to be seen in detail as to which scenario would fit your child best.
Hope this helps
Thank you