Lactateacidemic (lactic) coma

Description:

Lactateacidemic, or molochnokisyoly, a coma — the heaviest of a lump, vyyozvanny a diabetes mellitus. It razyovivatsya more often at the elderly people suffering from other chronic diseases (a liver, heart, kidneys), and also from alcoholism.

Reasons of a lactateacidemic (lactic) coma:

The lactateacidemic coma is not a specific acute complication of a diabetes mellitus and can develop at a number of states at which the phenomena of an anoxia and shock are noted (a myocardial infarction, diseases of a liver, kidneys, leukemia, enzymatic frustration and others).
Most often the long time accepting guanyl guanidines occurs at patients (Adebitum, глибутид, Buforminum, силубин). In the mechanism of its development the metabolic acidosis caused by significant increase in content in blood of milk and pyroracemic acids matters.

SD in itself seldom leads to a lactacidemia though earlier lactacidemia cases at the patients receiving therapy by guanyl guanidine, Phenforminum and, to a lesser extent, Buforminum, however at use of other drug from group of guanyl guanidines – Metforminum were noted – this complication comes to light extremely seldom

Symptoms of a lactateacidemic (lactic) coma:

Symptoms of a lactacidemia are generally caused by shifts of an acid-base state. In a clinical picture into the forefront quickly progressing cardiovascular insufficiency leading to development of a collapse, arterial hypotonia, hypoxia of a brain and disturbance of consciousness acts.
The hyperventilation is characteristic, however dehydration is expressed unsharply. Level of glucose of blood can vary considerably, and at some patients the hypoglycemia is noted. As symptoms of a lactacidemia are not specific, the diagnosis of a lactateacidemic coma has to be suspected at sick SD with hypotension or of state of shock if expressiveness of acidosis does not correspond to ketosis degree.
Duration of its development fluctuates from several hours to several days. At patients appetite decreases and disappears, nausea, vomiting, a headache and pain behind a breast develop, muscular weakness increases. Appear muscle pain at an exercise stress, apathy, sometimes excitement with sleeplessness. Then arise the drowsiness turning into disturbance of consciousness with nonsense, a loss of consciousness. Dehydration phenomena are noted. Kussmaul's breath, inodorous acetone. Tachycardia. The ABP decreases up to development of a collapse. The oligoanuriya develops. The hypothermia is noted. There is no expressed hyperglycemia, a glucosuria, a ketonemiya.

Though at all patients with a lactacidemia some increase in level of ketonic bodies in blood is noted, at the same time it usually does not exceed 1/3 general contents of organic acids. Thus, the diagnosis of a lactateacidemic coma in many respects – the diagnosis of an exception. The final diagnosis is established on the basis of determination of content of lactic acid in blood.

Treatment of a lactateacidemic (lactic) coma:

Now there are no effective methods of therapy of a lactateacidemic coma. A main objective of treatment – correction of disturbances of circulation and elimination of arterial hypotension, other important point – correction of acidosis. For this purpose it is usually necessary to enter the bigger amount of sodium bicarbonate which is often exceeding 1000 mmol that, in turn, can increase the content of sodium in an organism and dictate need of carrying out a hemodialysis or peritoneal dialysis for correction of a hypernatremia. Efficiency of use of other therapeutic means at a lactacidemia, such as dichloroacetate (the activator dehydrogenase pyruvate), buffered solutions or methylene blue, remains unproven.