J. Lu, GA. Zello, E. Randell, K. Adeli, J. Krahn and QH. Meng (2011). Closing the anion gap: contribution of D-lactate to diabetic ketoacidosis. Clinica chimica acta; international journal of clinical chemistry, 412(3-4), 286-91. https://doi.org/10.1016/j.cca.2010.10.020

PubMed 21036159

[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.