Oneglio G, Barbero P L, Gamba S, Grassi G, Bruni B
Ann Osp Maria Vittoria Torino. 1979 Jan-Jun;22(1-6):38-55.
Blood lactate levels were determined by Lactate Analyzer 640 Kontron during the course of 7 cases of hyperglycemic hyperosmolar diabetic coma, with severe acidosis and more or less marked ketosis. In 5 cases lactate values were found in normal range; slight increases around 2 mmol/l were rapidly corrected following standard coma treatment. One of these cases presented with extreme acidosis and relatively mild hyperglycemia, with differential problems in regard to lactic acidosis. In 2 cases, the former with alcoholic cirrhosis, the latter with myocardial infarction, blood lactate was markedly increased; in the second case, full clinical recovery was accompanied by normalization of lactate levels. A previous biguanide treatment could be ruled out as a cause of lactic acidosis. Thus the association of lactic acidosis and diabetic ketoacidosis seems to be unusual in the absence of concurrent serious conditions. The semiautomatic determination of blood lactate, because of its remarkable prognostic importance, should be included among the routine procedures for the emergency treatment of diabetic coma.
在7例伴有严重酸中毒及或多或少明显酮症的高渗性非酮症糖尿病昏迷患者的病程中，采用康创640乳酸分析仪测定血乳酸水平。5例患者的乳酸值在正常范围内；在标准昏迷治疗后，约2 mmol/l的轻度升高迅速得到纠正。其中1例表现为极度酸中毒和相对轻度的高血糖，存在乳酸酸中毒的鉴别问题。2例患者中，1例有酒精性肝硬化，另1例有心肌梗死，血乳酸明显升高；在第二例中，临床完全恢复伴随着乳酸水平的正常化。可以排除既往双胍类治疗作为乳酸酸中毒的原因。因此，在没有并发严重疾病的情况下，乳酸酸中毒与糖尿病酮症酸中毒的关联似乎并不常见。由于半自动测定血乳酸具有显著的预后重要性，应将其纳入糖尿病昏迷急诊治疗的常规程序中。
