Lactate kinetics in intensive care unit admissions due to diabetic ketoacidosis

Özet

Aims: We conducted this study to investigate the clinical significance of lactate kinetics inpatients admitted to the intensive care unit (ICU) for diabetic ketoacidosis (DKA).Methods: This retrospective study was conducted between November 1, 2016, and December31, 2020. Serial lactate measurements (at the hospital admission, ICU admission, and in 24hours periods until 48 hours of ICU stay) of the patients admitted to our ICU with a diagnosisof DKA were recorded.Results: Forty patients were included in the study (mean age: 50.6±19.4 years, female 60%).Eighty-five percent (n=34) of patients had increased (>2 mmol/L) blood lactate levels onadmission. There was no significant difference between the low (lactate <4 mmol/L) and highlactate(lactate ≥4 mmol/L) groups in mortality (p=0.195), ICU stay (p=0.966) and hospitallength of stay (LOS) (p=0.274). However, the group with less than 40% decrease in lactate levelfrom hospital admission to ICU had significantly higher Acute Physiology and Chronic HealthAssessment II score [24 (12-46) vs. 18 (2-27), p=0.007], longer ICU stay [5 (1-40) vs. 3 (2-8) days,p=0.032], and higher mortality rate [6 (26.1) vs. 0 (0.0), p=0.030]. Additionally, non-survivors(n=6) had significantly higher lactate levels at hospital admission [3.0 (1.3-15.0) vs. 5.1 (3.9-13.5) mmol/L, p=0.017], and ICU admission [2.3 (0.6-9.4) vs. 5.0 (2.4-16.0) mmol/L, p=0.010]than survivors.Conclusions: Although the ICU LOS and mortality did not differ between initial high and lowlactategroups in the present study, the lactate kinetics, especially in the early treatment period,can guide referral to the ICU level of care and determine the DKA patients at higher risk of death.