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Disease, diabetes, lactic acidosis Name: diabetic lactic acidosis respective areas: the systemic treatment department: Department of Endocrinology, signs and symptoms: Other symptoms of low blood pressure, diarrhea, nausea and vomiting, the differential diagnosis of metabolic acidosis
Diabetes, lactic acidosis and the diseases easily confused?
Differential diagnosis of diabetic coma diabetic coma medication history physical disease onset history of low blood sugar suddenly laboratory sweating, palpitation, character abnormalities, coma insulin, glibenclamide and other dilated pupils, fast heartbeat, sweating, blurred consciousness, coma, blood glucose <2.8 mmol / L (50mg/dl) urinary glucose (-) 1-24h ketoacidosis, polyuria, thirst, nausea, vomiting, abdominal pain, no medication history or stop insulin glucose breath with mild to moderate dehydration Kusmaul 16.7-33.3mmol / L , urine sugar, urine ketone strong positive non-ketotic hyperosmolar diabetic coma 1-14d old age, dehydration, 40% can be no history of diabetes diuretics, hormones, dialysis, severe dehydration, blood pressure, blood glucose has pathologic reflex 33.3mmol / L, urine positive, ketone (-) or ( ), the effective plasma osmola 320-340mosm / l lactic acidosis, liver and kidney 1-24h with a history of cardiopulmonary biguanide (phenformin, etc) deep breathing, skin flushing, fever , deep coma and blood lac 5mmol / L, ani8mmol / L, blood PH <7.35 diabetic lactic acidosis symptoms similar to appendicit


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Diabetic disease, the identification of lactic acidosis
First, with its causes coma and acidosis phase identification. Such as diabetic ketoacidosis, diabetic hyperosmolar nonketotic coma of low blood sugar. In addition to their reasons should also be differentiated from lactic acidosis.
First, the fluid in addition significant cardiac dysfunction and renal insufficiency, it should be corrected as soon as dehydration, saline and glucose sugar-based.
Second, continuous insulin infusion rate to 0.1u/kg-h promote the Krebs cycle, so that is also acid degradation, long time, the amount of no more, to prevent low blood sugar.
Third, vitamin C dose continuous intravenous infusion, in favor of glucose oxidation.
Fourth, alkaline liquid efficacy of suspicious and can make further intracellular fluid and cerebrospinal fluid of cerebral edema induced by acid and can not be any lower rate, it has direct life-threatening poisoning in addition, shall be used with caution in alkaline liquid.
Fifth, the amount of oxygen to improve tissue oxygen supply, promote lactic acid oxidation, diabetes and more low arterial oxygen pressure, oxygen is conducive to correct the lactic acidosis.
VI, hemodialysis or plasma exchange in critically ill patients
Seven, treatment incentives to correct hypoxia, disable biguanide hypoglycemic agents, anti-infection. Prognosis can not directly remove the blood within the brain in particular, lactic acid, so the effect is poor, mortality is higher.



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