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Severe Lactic Acidosis in a Diabetic Patient after Ethanol Abuse and Floor Cleaner Intake
Author(s) -
Hendrikx Jeroen J. M. A.,
Lagas Jurjen S.,
Daling Ratana,
Hooijberg Jan Hendrik,
Schellens Jan H. M.,
Beijnen Jos H.,
Brandjes Desiderius P. M.,
Huitema Alwin D. R.
Publication year - 2014
Publication title -
basic and clinical pharmacology and toxicology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.805
H-Index - 90
eISSN - 1742-7843
pISSN - 1742-7835
DOI - 10.1111/bcpt.12251
Subject(s) - diabetic ketoacidosis , lactic acidosis , ketoacidosis , medicine , acidosis , ingestion , diabetes mellitus , metabolic acidosis , citric acid , sodium bicarbonate , thiamine , insulin , lactic acid , endocrinology , anesthesia , type 1 diabetes , chemistry , food science , biology , bacteria , genetics
An intoxication with drugs, ethanol or cleaning solvents may cause a complex clinical scenario if multiple agents have been ingested simultaneously. The situation can become even more complex in patients with (multiple) co‐morbidities. A 59‐year‐old man with type 2 diabetes mellitus (without treatment two weeks before the intoxication) intentionally ingested a substantial amount of ethanol along with ~750 mL of laminate floor cleaner containing citric acid. The patient was admitted with severe metabolic acidosis (both ketoacidosis and lactic acidosis, with serum lactate levels of 22 mM). He was treated with sodium bicarbonate, insulin and thiamine after which he recovered within two days. Diabetic ketoacidosis and lactic acidosis aggravated due to ethanol intoxication, thiamine deficiency and citrate. The high lactate levels were explained by excessive lactate formation caused by the combination of untreated diabetes mellitus, thiamine deficiency and ethanol abuse. Metabolic acidosis in diabetes is multi‐factorial, and the clinical situation may be further complicated, when ingestion of ethanol and toxic agents are involved. Here, we reported a patient in whom diabetic ketoacidosis was accompanied by severe lactic acidosis as a result of citric acid and mainly ethanol ingestion and a possible thiamine deficiency. In the presence of lactic acidosis in diabetic ketoacidosis, physicians need to consider thiamine deficiency and ingestion of ethanol or other toxins.