Extreme metabolic acidosis. Case report.

A 42-year-old male patient, who suffered from insulin-dependent diabetes mellitus (IDDM) and intolerance of lactose, presented with extreme metabolic acidosis (lactic acidosis). On arrival, an arterial blood sample showed: pH 6.79, PO2 18.8 kPa, PCO2 0.9 kPa, base excess-33 mmol l-1, blood glucose 38 mmol l-1 and oesophageal temperature 30 degrees C. Apart from the uncontrolled hyperglycaemia, a fluid balance disorder elicited by diarrhoea and disturbed tissue perfusion were possible aetiological factors. The patient was treated with a low-dose insulin regimen and infusion of isotonic sodium bicarbonate with a satisfactory result.