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Lactic acidosis in diabetic patients

M Fulop, H D Hoberman, J H Rascoff

    Archives of Internal Medicine
    |September 1, 1976
    PubMed
    Summary

    Diabetic ketoacidosis and lactic acidosis can coexist. Beta-hydroxybutyrate levels can be elevated even with low plasma lactate, indicating ketoacidosis, and the nitroprusside test may be misleading.

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    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.

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