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. 2012 Apr;27(2):132-7.
doi: 10.1016/j.jcrc.2011.07.071. Epub 2011 Oct 26.

Prevalence and significance of lactic acidosis in diabetic ketoacidosis

Kristin Cox  1 , Michael N Cocchi, Justin D Salciccioli, Erin Carney, Michael Howell, Michael W Donnino
Affiliations

Prevalence and significance of lactic acidosis in diabetic ketoacidosis

Kristin Cox et al. J Crit Care. 2012 Apr.

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.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Initial lactate levels in patients with DKA.
Fig. 2
Fig. 2
Lactate levels and LOSs. In patients with DKA, lactate was not associated with ICU LOS (P = .37) or hospital LOS (P = .39). A, ICU LOS. B, Hospital LOS.
Fig. 3
Fig. 3
Relationship of glucose levels and lactate. Initial glucose levels were correlated with initial lactate levels (Spearman correlation coefficient, 0.34; P = .004).
Fig. 4
Fig. 4
Mortality in patients with DKA compared with patients with sepsis. The mortality of patients in DKA stratified by lactate levels is compared with the mortality for patients with sepsis obtained from data collected in the study of Howell et al [14].
See this image and copyright information in PMC

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