| disease | Diabetic Lactic Acidosis |
It is a clinical syndrome caused by abnormal biochemical changes resulting from various factors leading to persistently elevated blood lactate levels and decreased pH (<7.35), with severe consequences and high mortality.
bubble_chart Diagnosis
1. Medical History and Symptoms:
Commonly seen in diabetic patients taking large amounts of biguanide drugs, those with concurrent infections, sepsis, or severe chronic diseases of the heart, lungs, liver, or kidneys are also prone to increased lactate production and metabolic disorders. Main symptoms include nausea, vomiting, diarrhea, etc.
2. Physical Examination Findings:
Low body temperature, deep and rapid breathing, flushed skin, decreased blood pressure, shock, and impaired consciousness.
3. Auxiliary Examinations:
Elevated blood lactate (>5mmol/L), blood pH <7.35，陰離子間隙> 18mmol/L, NaHCO3<20mmol/L。
4. Differential Diagnosis
Differential diagnosis of diabetic unconsciousness
| Diabetic unconsciousness | Onset | Medical history | Medication history | Physical signs | Laboratory tests |
| Hypoglycemia | Sudden | Sweating, flusteredness, personality changes, unconsciousness | Insulin, glibenclamide, etc. | Dilated pupils, rapid heartbeat, sweating, confusion, unconsciousness | Blood sugar <2.8mmol/L(50mg/dl)尿糖(-) |
| Ketoacidosis | 1–24h | Polyuria, thirst, nausea, vomiting, abdominal pain | No medication history or insulin cessation | Mild grade II dehydration Kussmaul breathing | Blood sugar 16.7–33.3mmol/L, strongly positive urine glucose and ketones |
| Nonketotic hyperosmolar diabetic unconsciousness | 1–14d | Elderly, dehydration, 40% may have no history of diabetes | Diuretics, hormones, dialysis | Severe dehydration, decreased blood pressure, pathological reflexes | Blood sugar often >33.3mmol/L, positive urine glucose, urine ketones (-) or (±), effective plasma osmolality >320–340mosm/L |
| Lactic acidosis | 1–24h | History of heart, lung, liver, or kidney disease | Biguanides (e.g., phenformin) | Deep breathing, flushed skin, fever, deep unconsciousness | Blood lactate >5mmol/L, anion gap >18mmol/L, blood pH <7.35 |
bubble_chart Treatment Measures
1. Prevention should be prioritized, with timely detection and treatment, and oxygen therapy when necessary.
2. Fluid resuscitation can improve tissue perfusion, correct shock, and promote diuresis and acid excretion. Use normal saline and avoid lactate-containing solutions.
3. Alkali supplementation: Administer 100–200ml of 5% sodium bicarbonate IV, and discontinue alkali infusion when pH >7.25 to prevent alkalosis.
4. Insulin: Administer insulin with glucose via IV drip to reduce anaerobic glycolysis of carbohydrates and facilitate lactate clearance.
5. Hemodialysis: Commonly used for patients with fluid and sodium retention who cannot tolerate it.
