Elderly Diabetic Woman Experiences Severe Lactic Acidosis After Acute Gastroenteritis
A 65-year-old woman with a history of well-managed diabetes developed severe symptoms following an episode of acute gastroenteritis. She experienced excessive thirst, difficulty breathing, and increasing drowsiness. Blood gas analysis revealed metabolic acidosis with significantly elevated lactate levels, mild hyperglycemia, and positive urinary ketones. The diagnosis was lactic acidosis, a serious type of acid-base imbalance. Prompt treatment including fluid resuscitation, insulin therapy, correction of acidosis, and antibiotics led to a successful recovery within five days.
Initial Presentation
The patient, a 65-year-old female, had a stable history of diabetes but no major complications. She was brought to the hospital after experiencing nausea, vomiting, abdominal cramps, and watery diarrhea for two days, followed by four hours of labored breathing and progressive fatigue. Her family noticed worsening shortness of breath and mild lethargy before seeking emergency care. Upon admission, her blood pressure was low at 90/60 mmHg (normally around 110/80 mmHg), and her heart rate was elevated at 102 bpm. Blood gas tests showed a pH of 7.05, HCO3- at 3.3 mmol/L, and lactate levels exceeding 15 mmol/L—clear indicators of severe lactic acidosis. Urinalysis confirmed the presence of ketones and protein, while chest CT scans showed no abnormalities.
Treatment Plan and Progress
Due to the severity of her condition and high lactate levels, the medical team immediately informed the family about the critical nature of her illness and admitted her for urgent treatment. Further lab work and abdominal ultrasound ruled out other potential causes such as acute abdomen. Lab results showed elevated white blood cell count, slightly impaired kidney function, and normal potassium levels. Intravenous saline was administered to restore blood volume and improve tissue perfusion. Sodium bicarbonate was used to correct acidosis, with frequent blood gas monitoring to adjust dosages accordingly. Insulin and glucose were given to stabilize blood sugar and reduce anaerobic glycolysis, thereby lowering lactate production. Cefotaxime was prescribed to treat any possible infection, while potassium supplements were carefully monitored and administered to prevent hypokalemia during insulin therapy.
Rapid Recovery Observed
Within three hours of aggressive hydration, the patient's blood pressure stabilized to her baseline, and urine output improved to over 40 ml per hour. Over the next 12 hours, her lactate levels dropped significantly, and her mental status returned to normal. Symptoms like nausea, vomiting, and shortness of breath subsided, and she was able to tolerate oral fluids and soft foods. By day five, all gastrointestinal symptoms had resolved, and follow-up blood tests showed a pH of 7.42, lactate at 1.0 mmol/L, and normal organ function. Her white blood cell count also normalized, and she was discharged in stable condition.
Post-Treatment Recommendations
After successful treatment, it is crucial for patients like this to maintain good hydration and dietary habits. Drinking plenty of water and consuming fiber-rich foods such as cucumbers and cauliflower can help support digestive and metabolic health. Alcohol should be avoided, and diabetic patients must continue taking their medications regularly, monitor blood sugar closely, and seek early medical attention if they develop infections or gastrointestinal issues.
Clinical Insight and Patient Awareness
This case highlights how vulnerable diabetic individuals can be to metabolic complications like lactic acidosis after relatively common illnesses such as gastroenteritis. Symptoms like deep rapid breathing, dry mouth, extreme fatigue, and altered consciousness should raise red flags for caregivers. Immediate hospitalization and blood gas testing are essential for quick diagnosis and timely intervention. Recognizing these signs early can make a life-saving difference in managing acute metabolic emergencies.