Prevalence and significance of lactic acidosis in diabetic ketoacidosis

• Published in: Journal of critical care 2012-04, Vol.27 (2), p.132-137
• Main Authors: Cox, Kristin, MD, Cocchi, Michael N., MD, Salciccioli, Justin D., BA, Carney, Erin, BA, Howell, Michael, MD, MPH, Donnino, Michael W., MD
• Format: Article
• Language: English
• Subjects: Acidosis; Acidosis, Lactic - epidemiology; Adult; Critical Care; Diabetes; Diabetic ketoacidosis; Diabetic Ketoacidosis - metabolism; Diabetic Ketoacidosis - therapy; Disease; Emergency Service, Hospital; Female; Heart attacks; Hospital Mortality; Hospitalization; Hospitals; Hospitals, Urban; Humans; Illnesses; Intensive Care Units - statistics & numerical data; Lactic acidosis; Length of Stay - statistics & numerical data; Male; Metabolism; Middle Aged; Mortality; Prevalence; Retrospective Studies; Review boards; Sepsis; Treatment Outcome; Variables
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2011.07.071

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.