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Hyperlactatemia in diabetic ketoacidosis is common and can be prolonged: lactate time-series from 25 intensive care admissions

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Abstract

Hyperlactatemia is a documented complication of diabetic ketoacidosis (DKA). Lactate responses during DKA treatment have not been studied and were the focus of this investigation. Blood gas and electrolyte data from 25 DKA admissions to ICU were sequenced over 24 h from the first Emergency Department sample. Hyperlactatemia (> 2 mmol/L) was present in 22 of 25 DKA presentations [mean concentration = 3.2 mmol/L]. In 18 time-series (72%), all concentrations normalized in ≤ 2.6 h (aggregate decay t1/2 = 2.29 h). In the remaining 7 (28%), hyperlactatemia persisted > 12 h. These were females (P = 0.04) with relative anemia (hemoglobin concentrations 131 v 155 g/L; P = 0.004) and lower nadir glucose concentrations (5.2 v 8.0 mmol/L, P = 0.003). Their aggregate glucose decay curve commenced higher (42 mmol/L v 29 mmol/L), descending towards a lower asymptote (8 mmol/L v 11 mmol/L). Tonicity decay showed similar disparities. There was equivalent resolution of metabolic acidosis and similar lengths of stay in both groups. Hyperlactatemia is common in DKA. Resolution is often rapid, but high lactates can persist. Females with high glucose concentrations corrected aggressively are more at risk. Limiting initial hyperglycemia correction to ≥ 11 mmol/L may benefit.

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Project supported by Departmental Funds.

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Authors and Affiliations

  1. Mater Research, Mater Health Services and University of Queensland, Stanley Street, South Brisbane, Brisbane, QLD, 4101, Australia

    Thomas J. Morgan

  2. Intensive Care Unit, Mater Health Services, Stanley Street, South Brisbane, Brisbane, QLD, 4101, Australia

    Thomas J. Morgan & Peter H. Scott

  3. University of Queensland, Brisbane, QLD, 4072, Australia

    Christopher M. Anstey

  4. Griffith University, Gold Coast, Southport, QLD, 4215, Australia

    Christopher M. Anstey

  5. Department of Pathology, Royal Melbourne Hospital, and University of Melbourne, Parkville, VIC, 3050, Australia

    Francis G. Bowling

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This research was performed in accordance with the requirements of the National Statement on Ethical Conduct in Human Research (2007). The need for individual patient consent was waived by the Human Research Ethics Committee, Mater Research (HREC/18/MHS/22).

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Morgan, T.J., Scott, P.H., Anstey, C.M. et al. Hyperlactatemia in diabetic ketoacidosis is common and can be prolonged: lactate time-series from 25 intensive care admissions. J Clin Monit Comput 35, 757–764 (2021). https://doi.org/10.1007/s10877-020-00532-9

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