Diabetic Lactic acidosis causes and prevention
Posted on October 26, 2009
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Lactic acid is an intermediate metabolite of glycolysis. Under normal circumstances, lactate is about 50% to 60% in the liver into glycogen storage, about 30% ~ 35% of kidneys used. When the blood lactic acid increased more than 2mmol / L, blood pH is less than 7.35, when no other cause acidosis can be diagnosed as lactic acidosis. The disease mortality rate is high (50%), is one of the acute complications of diabetes. Common causes can be divided into two main categories:
(1) Due to lack of O.2 and shock caused by the state. Such as: ① shock. Due to myocardial infarction, heart failure, severe trauma, infection, bleeding caused by cardiac, infection, blood loss, dehydration shock. ② hypoxia asphyxia. Carbon monoxide poisoning, pulmonary embolism and infarction. ③ acute pancreatitis with shock.
(2) No state of hypoxia and shock caused by those. Found: ① drugs. Biguanide hypoglycemic agents, especially those caused by phenformin more common and severe. In addition: ethanol, methanol, xylitol, sorbitol, fructose, paracetamol, salicylic acid salts, streptozotocin, catecholamines, cyanide category, isoniazid, ethylene glycol can cause. ② systemic disease. Diabetic ketoacidosis may be associated with this disease, liver disease, kidney failure uremia, malignant tumors, leukemia, severe infection with sepsis, convulsions, anemia, hunger can cause this disease. ③ genetic disease. Glucose -6 – phosphate dehydrogenase deficiency, fructose 1,6 – dioxo-acid enzyme deficiency, the lack of pyruvate carboxylase, pyruvate dehydrogenase deficiency, oxidative phosphorylation defects may also cause this disease.
Because this disease death rate is high, so to strengthen the prevention measures are as follows: Where a liver and kidney dysfunction, better not biguanide hypoglycemic agents, diabetes, heart disease heart failure-prone, kidney circulation disorder may also affect the biguanide drug excretion, it should be used with caution; avoid the use of ethanol, methanol, xylitol, salicylic acid salts, isoniazid and other drugs, propranolol and other drugs be used with caution; as far as possible without fructose, sorbitol and the use of glucose, in order to avoid this disease ; where there is shock, hypoxia, liver and renal failure, acidosis state, shall be to correct hypoxia, ischemia, shock to correct the basic measures to prevent the occurrence of this disease.
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