Lactic acidosis in diabetic patients

Area of Science:

• Biochemistry
• Endocrinology
• Diabetology

Background:

• Diabetic ketoacidosis (DKA) and lactic acidosis (LA) are serious metabolic disturbances.
• Distinguishing between DKA and LA, especially when they coexist, is clinically important.
• Biochemical markers like plasma lactate and beta-hydroxybutyrate are crucial for diagnosis.

Purpose of the Study:

• To investigate plasma lactate and beta-hydroxybutyrate concentrations in diabetic patients experiencing ketoacidosis and lactic acidosis.
• To assess the utility of the nitroprusside test in differentiating these conditions.

Main Methods:

• Measurement of plasma lactate and beta-hydroxybutyrate concentrations in diabetic patients.
• Clinical assessment for ketoacidosis and lactic acidosis.
• Evaluation of serum reactions with sodium nitroprusside.

Main Results:

• In 39 ketoacidosis patients, 28 had normal lactate (<3.6 mmol/L) while 11 had elevated lactate; 7 of these 11 were suspected of coexisting LA.
• No correlation was found between plasma lactate and beta-hydroxybutyrate in the ketoacidosis group.
• In 10 presumed LA episodes, 6 showed elevated beta-hydroxybutyrate despite negative/weak nitroprusside tests.
• The nitroprusside test was misleadingly weak in 5 ketoacidosis patients, including 3 with low lactate.

Conclusions:

• Elevated beta-hydroxybutyrate can be present in diabetic ketoacidosis even with normal or moderately elevated lactate levels.
• Coexisting lactic acidosis in diabetics may present with elevated beta-hydroxybutyrate and potentially misleading nitroprusside test results.
• Relying solely on plasma lactate and the nitroprusside test can be insufficient for diagnosing or differentiating DKA and LA in diabetics.