alexa Closing the anion gap: contribution of D-lactate to diabetic ketoacidosis.
Diabetes & Endocrinology

Diabetes & Endocrinology

Journal of Diabetes & Metabolism

Author(s): Lu J, Zello GA, Randell E, Adeli K, Krahn J,

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Abstract BACKGROUND: A high anion gap in diabetic ketoacidosis (DKA) suggests that some unmeasured anions must contribute to the generation of the anion gap. We investigated the contribution of D-lactate to the anion gap in DKA. METHODS: Diabetic patients with and without DKA and high anion gap were recruited. Plasma D-lactate was quantified by HPLC. Plasma methylglyoxal was assayed by liquid chromatography-tandem mass spectrometry. RESULTS: The plasma fasting glucose, β-hydroxybutyrate, and blood HbA1c levels were highly elevated in DKA. Plasma anion gap was significantly increased in DKA (20.59±6.37) compared to either the diabetic (7.50±1.88) or the control group (6.53±1.75) (p<0.001, respectively). Moreover, plasma D-lactate levels were markedly increased in DKA (3.82±2.50 mmol/l) compared to the diabetic (0.47±0.55 mmol/l) or the control group (0.25±0.35 mmol/l) (p<0.001, respectively). Regression analysis demonstrated that D-lactate was associated with acidosis and anion gap (r=0.686, p<0.001). CONCLUSIONS: Plasma D-lactate levels are highly elevated and associated with metabolic acidosis and the high anion gap in DKA. Laboratory monitoring of d-lactate will provide valuable information for assessment of patients with DKA. Copyright © 2010 Elsevier B.V. All rights reserved. This article was published in Clin Chim Acta and referenced in Journal of Diabetes & Metabolism

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