Lactic Acidosis as a Cause of Nonketotic Acidosis in Diabetic Patients

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Abstract
SEVERE metabolic acidosis, when it occurs in diabetic patients, is generally the result of excessive hepatic production of acetoacetic and beta-hydroxybutyric acid. Exceptional cases of metabolic acidosis in diabetic patients whose urine has failed to give a positive reaction for acetoacetic acid have long been recognized.1 In certain cases increased concentrations of beta-oxybutyric acids have been demonstrated in the plasma. A failure of renal excretion of acetoacetic acid, usually attributed to shock, has been proposed as an explanation of these cases.2 , 3 In other cases examinations of the plasma or tissues for beta-oxybutyric acids by qualitative or quantitative procedures have failed . . .