Lactate kinetics in intensive care unit admissions due to diabetic ketoacidosis

Introduction Diabetic ketoacidosis (DKA) is primarily characterized by hyperglycemia, ketonemia, and acidosis with an increased anion gap. The number of cases with DKA has been increasing in the last two decades (1,2). The mortality rate of DKA varies across the world due to psychosocial and economic diversities; mainly, it has been reported as less than 1% (3,4). Although the risk of death is low, intensive care units (ICU) are still the places where these patients are primarily treated, and the prolongation of the ICU stays leads to an increase in hospital costs and ICU overcrowding. In addition, there are no specific criteria for determining whether the patients with DKA should be treated in the ICU or not. Increased blood lactate concentration, a significant prognostic predictor for many clinical conditions in critically ill patients, is also typical in patients with DKA (5). This may occur due to impaired glucose metabolism with hypoperfusion and poorly understood mechanisms such as the glyoxal pathway and alternative energy substrate in DKA. In addition, there are still controversies regarding the role of increased lactate levels in the course of DKA. Unfortunately, there are insufficient data to suggest that the lactate kinetics in DKA patients may help evaluate treatment response over time and ICU outcomes (6).