Prevalence and significance of lactic acidosis in diabetic ketoacidosis.
OBJECTIVE
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.
Beth Israel Deaconess Medical Center, Department of Medicine, Boston, MA 02215, USA.
Kristin
K
Cox
Michael N
MN
Cocchi
Justin D
JD
Salciccioli
Erin
E
Carney
Michael
M
Howell
Michael W
MW
Donnino
D000140:Acidosis, Lactic / Q000453:epidemiology*; D000328:Adult; D016883:Diabetic Ketoacidosis / Q000378:metabolism* / Q000628:therapy; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006786:Hospitals, Urban; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome