Lactacidemic diabetic coma

Lactacidemic diabetic coma is a comatose state characterized by a low level of glycemia, a decrease in the alkaline reserve of the blood, pH, and an increase in the level of lactic acid in the blood.

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Causes of lactic acidemia diabetic coma

The causes of lactic acidemic diabetic coma may be:

• chronic hypoxia in individuals with decompensated diabetes mellitus;
• severe dehydration of the body in hyperosmolar diabetic coma.

Symptoms of lactic acidemic diabetic coma

Over the course of several hours or several days, patients become increasingly weak, fatigue increases, and severe pains in the muscles and heart appear. Drowsiness develops into a coma. Symptoms of hyperventilation (Kussmaul breathing) are more pronounced than in ketoacidosis with similar pH values. The clinical feature of this type of coma is the development of hemodynamic problems (acute cardiovascular failure). Often, the cause of death is paralysis of the respiratory center.

Diagnosis criteria

Decreased alkaline reserve of the blood (BE 10 mmol/l and below), decreased acid-base balance (pH 7.2-6.8), increased lactic acid level in the blood (above 1.33 mmol/l). The level of ketone bodies in the blood is below 1.7 mol/l.

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Emergency care for lactic acidemic diabetic coma

A 4% sodium bicarbonate solution is administered intravenously by drip (25% of the fluid volume corresponding to the child's age norm), 0.9% sodium chloride solution. Then a 5% glucose solution up to 50% of the daily volume [at the rate of 100-150 ml/(kg x day)], ascorbic acid, cocarboxylase 50-100 mg.

Despite the relatively low level of glycemia in severe lactic acidosis, tissue sensitivity to insulin is low, which is why an increased rate of insulin administration is indicated [starting - 0.15 U/kg h). If pharmacological correction of the condition is ineffective, hemodialysis is necessary.

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