Elevated Lactic Acid During Ketoacidosis: Pathophysiology and Management

Area of Science:

• Internal Medicine
• Biochemistry
• Critical Care Medicine

Background:

• Lactic acidosis is an acid-base disorder caused by excess lactic acid, common in critically ill patients.
• Type A lactic acidosis stems from hypoperfusion (shock, trauma, hypoxemia).
• Type B lactic acidosis occurs without hypoperfusion, with diverse causes like seizures, liver failure, malignancies, enzyme/thiamine deficiencies, diabetes, and alcohol abuse.

Purpose of the Study:

• To describe a rare complication of type 1 Diabetes Mellitus (T1DM).
• To highlight the occurrence of persistent type B lactic acidosis during T1DM ketoacidosis.

Main Methods:

• Case report analysis.
• Review of clinical presentation and biochemical markers.

Main Results:

• A rare case of type B lactic acidosis during T1DM ketoacidosis is presented.
• The acidosis was major and persistent, occurring without evidence of hypoperfusion or shock.

Conclusions:

• Type 1 Diabetes Mellitus can present with a rare, persistent form of type B lactic acidosis during ketoacidosis.
• This emphasizes the need to consider diverse etiologies of hyperlactatemia in diabetic patients.