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Diabetic Lactic Acidosis: Medical Significance, Clinical Presentations, Classifications And Treatment

Updated on February 18, 2014

Diabetic Lactic Acidosis

The hypoxic state produced by aberrations in tissue metabolism probably contributes to the lactic acidosis associated with severe diabetes. Biguanides, especially phenformin, aggravate this situation by inhibiting gluconeogenesis and mitochondrial el
The hypoxic state produced by aberrations in tissue metabolism probably contributes to the lactic acidosis associated with severe diabetes. Biguanides, especially phenformin, aggravate this situation by inhibiting gluconeogenesis and mitochondrial el | Source

A General overview

In this form of metabolic acidosis, the blood lactate level is increased above 5 mmol/liter and the arterial pH is 7.25 or less. The normal blood lactate level ranges between 5 and 18 mg/dl (up to 2 mmol/liter). This is maintained by the balance between production and utilization of lactate. Though, lactate is produced in all tissues, the brain, red blood cells, skeletal muscle, and skin account for major part of this metabolite. It is utilized mainly in the liver and kidneys. Lactic acidosis has been divided into types A and B. In type A, there is hypotension and tissue anoxia. In type B, there is no evidence of tissue anoxia. Type B, there is further subdivided into types B1, B2 and B3 based on its etiology.

Classification Of Lactic Acidosis (Cohen and Woods, 1979)

Type A (with tissue hypoxia)
B1 Common disorders
B2 Drugs and toxins
B3 hereditary form
Biguanides
Diabetes Mellitus
Biguanides
Type I- Glycogen storage disease
Cardiogenic shock
Renal Failure
Parenteral alimentation (Fructose, Sorbitol and Xylitol)
Fructose 1,6 diphosphatase deficiency
Endotoxic shock and severe Anemia
Liver diseases and infections
Ethanol
Methylmalonic academia (Leigh’s syndrome).
Left ventricular failure
Leukemia
Salicylates and methanol
 

The Usual Lactic Acidosis In The Knees

 In 80% of the patients, the condition starts with gastrointestinal problems, followed by sudden alteration in the sensorium, loss of consciousness, hypotension, Kussmaul’s breathing, hypothermia, severe dehydration and circulatory collapse
In 80% of the patients, the condition starts with gastrointestinal problems, followed by sudden alteration in the sensorium, loss of consciousness, hypotension, Kussmaul’s breathing, hypothermia, severe dehydration and circulatory collapse | Source

Diabetic Lactic Acidosis

The hypoxic state produced by aberrations in tissue metabolism probably contributes to the lactic acidosis associated with severe diabetes. Biguanides, especially phenformin, aggravate this situation by inhibiting gluconeogenesis and mitochondrial electron transport chain.

Clinical features: In 80% of the patients, the condition starts with gastrointestinal problems, followed by sudden alteration in the sensorium, loss of consciousness, hypotension, Kussmaul’s breathing, hypothermia, severe dehydration and circulatory collapse. Diagnosis should be confirmed by estimating plasma lactate/pyruvate ratio (L/P) is above 15. Arterial pH is below 7.25 and plasma bicarbonate is bwloe 22 meq/liter. The anion gap which indicates the unmeasured anions in blood [Na+ - (Cl- + HCO3-)] is above the normal range of 4 to 12 mmol/liter. In the absence of ketonuria, an increased anion gap in a diabetic is almost diagnostic of lactic acidosis. The mortality exceeds 50% in most series.

Treatment: The principles of treatment comprises of correction of shock, tissue hypoxia, and acidosis. Attempts have been made to remove toxic metabolites by hemodialysis. Insulin therapy speeds up recovery from lactic acidosis occurring in diabetics. THAM and methylene blue have been used as buffers, but their value remains doubtful. Sodium bicarbonate is given to counteract acidosis. It should be used with great caution since volume overload, worsening of acidosis and rebound alkalosis may develop. The total dose of bicarbonate can be calculated as follows.

Total requirement of bicarbonate (mmol) = 25- (plasma bicarbonate in mmol/liter X body weight in Kg X 0.3).

Diabetic lactic acidosis is a major complication to anticipate with caution, because it has proven fatal in some diabetics over the years.

© 2014 Funom Theophilus Makama

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    • married2medicine profile image
      Author

      Funom Theophilus Makama 4 years ago from Europe

      Thank you Faith Reaper

    • Faith Reaper profile image

      Faith Reaper 4 years ago from southern USA

      Great hub here full of insightful information.

      Up and more and sharing

      Blessings,

      Faith Reaper

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