Some individuals with mitochondrial diseases appear more sensitive to physiologic stressors such as minor illness, dehydration, fever, temperature extremes, surgery, anaesthesia, and prolonged fasting or starvation.
During such stress, rapid systemic decompensation may occur which may result in temporary or permanent worsening of the condition.
Preventive measures are aimed at avoiding (or at least not making any worse) such decompensation include:
- Eat regularly, avoid fasting and intentional weight loss
- stay well hydrated (early administration of oral and/or IV fluids & dextrose during illness)
- correcting lactic acidosis: this often responds to rehydration with intravenous fluids but in some circumstances administration of sodium bicarbonate is required. Dichloroacetate causes nerve damage and is reserved for very severe acidosis unresponsive to sodium bicarbonate and fluids.
- avoiding exposure to pharmacologic mitochondrial toxins (alcohol, cigarettes)
- providing cofactor and/or vitamin therapies.
- protection from infectious diseases.
Exercise has been shown to reduce the burden of unhealthy mitochondria, increase % of healthy mtDNA and improve endurance and muscle function.
Whenever possible, exercise is advised by clinicians but regimes should be supervised by a professional and patients should start at a very low intensity and brief duration and should progress gradually. Resistance exercise (using weights) can be performed by many patients and can increase strength.
Exercise regimes should be halted during an illness.