Part 10: Acute complications of diabetes: Coma due to Lactic Acidosis.

1. Clinical signs:

The onset is often sudden, coma occurs very quickly, after a few hours. Symptoms include:

- Vomiting, pale skin, impaired consciousness, drowsiness.

- Body temperature drops, blood pressure drops, cardiovascular collapse.

- Kussmaul breathing.

- Oliguria or anuria.

2. Paraclinical signs:

- Moderate increase in blood sugar.

- Increased lactic acid (normal lactic acid 0.56 - 2.2 mmol/l).

- Alkaline reserves decrease, blood pH decreases.

- K+ increases in renal failure.

- Increased white blood cells.

3. Treatment.

- Treat the cause of lactic acidosis.

- Good ventilation, restore blood pressure and prevent cardiovascular collapse.

=> Anti-acidification of blood:

Nabica is administered at the following doses:

HC03 = (25 mỌq/l HC03 - measured HC03) x 0.5 (weight in kg).

=> Rapid insulin infusion is similar to the dose for treating ketoacidosis coma.

=> Treat heart failure with ouabain or digoxin. If blood pressure drops, increase blood pressure with drugs (dopamine, dobutrex).

=> Replenish water and electrolytes by infusing THM solution 9‰, ringer lactate or 5% glucose.

=> If there is kidney failure: Hemodialysis or peritoneal dialysis.

Doctor Nguyen Van Hoan (Director of Provincial Endocrinology Hospital)