D-lactate in diabetic ketoacidosis
This well conducted case study demonstrates clearly the role of
lactic acid. A significant part of the lactate load is due to D-lactic
acid enantiomer (1). It is the end product of the glyoxalase system that
metabolises methylglyoxal, a major intracellular glucose metabolite.
Use of biguanides is also associated with a reduced oxygen
consumption (2) which adds to the propensity of acidosis.
D-lactate is metabolised by a high Km mitochondrial D-lactate
oxidase. Therefore, its clearance is much slower than that of the L-
D-lactate can be analysed with a low-cost technique in blood and
1 Christopher MM, Broussard JD, Fallin CW, et al. Increased serum D-
lactate associated with diabetic ketoacidosis. Metabolism 1995; 44: 287
2 Protti, A, Russo, R, Tagliabue P et al. Oxygen consumption is
depressed in patients with lactic acidosis due to biguanide intoxication.
Crit care 2010; 14: R22
3 Talasniemi JP, Pennanen S, Savolainen H, et al. Assay of D-lactate
in diabetic plasma and urine. Clin Biochem 2008; 41: 1099
Competing interests: No competing interests