Lactacidemic diabetic coma

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

[1], [2], [3], [4], [5], [6]

Causes of lactacidemic diabetic coma

The cause of lactacidemic diabetic coma may be:

• chronic hypoxia in persons with diabetes decompensation;
• severe dehydration of the body with hyperosmolar diabetic coma.

[7], [8], [9], [10]

Symptoms of lactacidemic diabetic coma

In a few hours or several days, the patients develop weakness. Increased fatigue, there are severe pain in the muscles and heart. Sleepiness goes into a coma. Symptoms of hyperventilation (respiration of Kussmaul) are more pronounced than in ketoacidosis with similar pH values. The clinical peculiarity of this variant of coma is the development of hemodynamic problems (acute cardiovascular failure). Often the cause of death is paralysis of the respiratory center.

Criteria for diagnosis

Reduction of the alkaline reserve of blood (BE 10 mmol / L and lower), decrease in the acid-base state (pH 7.2-6.8), the level of lactic acid (above 1.33 mmol / l) is increased in the blood. The level of ketone bodies in the blood is lower than 1.7 mol / l.

[11], [12], [13], [14], [15], [16]

Emergency care for lactic acid diabetic coma

Introduce a 4% solution of sodium bicarbonate, intravenously drip (25% of the volume of fluid corresponding to the child's age), 0.9% sodium chloride solution. Then 5% glucose solution to 50% of the daily volume [from the calculation of 100-150 ml / (kghsut)] ascorbic acid, cocarboxylase 50-100 mg.

Despite the relatively low level of glycemia with expressed lactic acidosis, the sensitivity of tissues to insulin is low, which is why an increased insulin delivery rate is shown [starting - 0.15 U / kghh]]. At low efficiency of pharmacological correction of the condition, hemodialysis is necessary.

[17], [18], [19], [20], [21]