Diabetic lactic acidosis

Introduction to Diabetes Induced Acidic Acidosis Metabolites of anaerobic glycolysis in the body, acidosis caused by elevated lactic acid in the blood, clinical syndrome caused by abnormal increase in blood lactate and abnormal biochemical changes in pH (<7.35). Lactic acidosis caused by various causes in diabetic patients is called diabetic lactic acidosis. Most of the disease occurs in elderly patients with diabetes, the incidence rate, diagnosis rate is low, and the mortality rate is extremely high. basic knowledge The proportion of illness: 0.003% Susceptible people: seen in the elderly Mode of infection: non-infectious Complications: Diabetic ketoacidosis Non-ketotic hyperglycemia - hyperosmolar coma Diabetic neuropathy Diabetic nephropathy Diabetic retinopathy

Causes of lactic acidosis in diabetes

Vascular lesions (35%):

Diabetic patients with large blood vessels and microvascular disease, resulting in poor tissue and organ perfusion; increased glycosylated hemoglobin levels, decreased hemoglobin oxygen carrying capacity, can cause local hypoxia and increase lactic acid production.

Cellular hypoxia (30%):

The heart, liver and kidney diseases of patients with diabetes make the tissue and organ perfusion poor, hypoxemia; the patient's glycosylated hemoglobin level is increased, the hemoglobin oxygen-carrying capacity is decreased, and the local hypoxia is more likely to cause the increase of lactic acid production.

Metabolic disorders (25%):

Diabetic patients often have pyruvate oxidative disorders and lactic acid metabolism defects, so there is usually high lactateemia.

Diabetes lactic acidosis prevention

Once lactic acidosis occurs, the mortality rate is extremely high. The specific preventive measures are as follows:

1. Do not use phenformin in the treatment of diabetes. All patients with diabetic nephropathy, liver and kidney dysfunction, older than 70 years of age, and poor cardiopulmonary function should not be used. People with poor diabetes control can be treated with insulin.

2. Actively treat various diseases that can induce lactic acidosis.

3. Diabetes patients should abstain from alcohol and try not to use drugs that can cause lactic acidosis.

Diabetes lactic acidosis complications Complications Diabetic ketoacidosis Non-ketotic hyperglycemia - Hyperosmolar coma Diabetic neuropathy Diabetic nephropathy Diabetic retinopathy

Diabetic ketoacidosis, non-ketotic hyperosmolar coma, diabetic lactic acidosis, diabetic heart disease, diabetic cerebrovascular disease, diabetic extremity gangrene, diabetic neuropathy, diabetic nephropathy, diabetic retina Lesions, as well as a variety of infections caused by diabetes.

Symptoms of lactic acidosis in diabetes common symptoms diarrhea nausea shock blood pressure drop consciousness disorder diabetes

Diabetes lactic acidosis is acute, but the symptoms and signs are not specific.

Mildness: only fatigue, nausea, loss of appetite, dizziness, lethargy, and a little deeper breathing.

Moderate to severe: nausea, vomiting, headache, dizziness, weak body, cyanosis, deep breathing, but no ketone, blood pressure, weak pulse, fast heart rate, dehydration, disturbance of consciousness, weakened limbs, Decreased muscle tone, enlarged pupils, deep coma or shock.

Diabetes lactic acidosis check

1, physical examination: low body temperature, deep and large breathing, skin flushing, blood pressure, shock, disturbance of consciousness.

2. Auxiliary examination: blood lactic acid increased (>5mmol/L), blood pH<7.35, anion gap>18mmol/L, NaHCO3<20mmol/L, blood glucose <2.8mmol/L (50mg/dl) urine sugar (-) , plasma effective osmotic pressure> 320-340mosm / l, CO2 binding capacity decreased, pyruvic acid increased, lactic acid / pyruvate 30, blood ketone body generally does not rise.

Diagnosis and diagnosis of diabetic lactic acidosis

1, diabetic ketoacidosis: more common in type 1 diabetes or some type 2 diabetes patients with acute complications. Features: deep breathing, ketone flavor (rotten apple flavor), strong positive ketone body, blood ketone, blood sugar significantly increased, pH <7.30.

2, diabetes hyperosmolar coma: more common in elderly people with diabetes without proper control of the disease and a large number of water loss, can also be seen in a small number of type 1 diabetes. Characteristics: blood glucose>33.3mmol/L; plasma osmotic pressure>350mOsm/L, or effective osmotic pressure>320mOsm/L; blood sodium>145mmol/L; normal or high blood ketone, urinary ketone (-) or weak positive; CO2CP normal Or low; blood pH around 7.35 or normal. There are many signs of nervous system in the signs, especially focal motor nerve disorders, blood pressure rise, sometimes accompanied by stroke and coronary heart, and sometimes coexist with DKA, need to be identified.

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