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Clin Chim Acta. 2011 Jan 30;412(3-4):286-91. doi: 10.1016/j.cca.2010.10.020. Epub 2010 Oct 29.

Closing the anion gap: contribution of D-lactate to diabetic ketoacidosis.

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  • 1Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine, Wenzhou Medical College, Wenzhou, China.



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.


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.


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).


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.

[PubMed - indexed for MEDLINE]
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