Prevalence and significance of lactic acidosis in diabetic ketoacidosis

Abstract

Purpose The prevalence and clinical significance of lactic acidosis in diabetic ketoacidosis (DKA) are understudied. The objective of this study was to determine the prevalence of lactic acidosis in DKA and its association with intensive care unit (ICU) length of stay (LOS) and mortality. Methods Retrospective, observational study of patients with DKA presenting to the emergency department of an urban tertiary care hospital between January 2004 and June 2008. Results Sixty-eight patients with DKA who presented to the emergency department were included in the analysis. Of 68 patients, 46 (68%) had lactic acidosis (lactate, >2.5 mmol/L), and 27 (40%) of 68 had a high lactate (>4 mmol/L). The median lactate was 3.5 mmol/L (interquartile range, 3.32–4.12). There was no association between lactate and ICU LOS in a multivariable model controlling for Acute Physiology and Chronic Health Evaluation II, glucose, and creatinine. Lactate correlated negatively with blood pressure (r = −0.44; P < .001) and positively with glucose (r = 0.34; P = .004). Conclusions Lactic acidosis is more common in DKA than traditionally appreciated and is not associated with increased ICU LOS or mortality. The positive correlation of lactate with glucose raises the possibility that lactic acidosis in DKA may be due not only to hypoperfusion but also to altered glucose metabolism.

Acute metabolic complications of diabetes mellitus in a tertiary care center

“…14 Diabetic ketoacidosis, HHNKS, lactic acidosis and hypoglycemia presented in varying combinations in some patients, similar findings were seen in the study conducted by Cox K et al 15 Diabetic ketoacidosis was commonly associated with lactic acidosis. Hypoglycemia was associated with all other metabolic complications of diabetes mellitus.…”

Lactic acidosis in diabetic ketoacidosis

“…More recently, however, it was demonstrated that the metabolic derangements itself present in DKA might contribute as well to the elevated lactate levels 4. Various studies have reported the presence of a positive correlation between glucose levels and ketone (β-hydroxybutyrate) levels on the one hand, and lactate levels on the other hand 4 5.…”

Lactate as a diagnostic marker in transient loss of consciousness

“…Levels around 4-5 mmol/l are universally accepted as being elevated. Such serum lactate concentrations in conjunction with a blood pH value of ≤ 7.35 constitute a lactic acidosis (10)(11)(12).…”