Increasing lactate levels during treatment of diabetic ketoacidosis

A young woman with type 1 diabetes mellitus and severe diabetic ketoacidosis was treated in an intensive care unit according to the guidelines. Only a few hours after starting the therapy, rising lactate values were diagnosed in the arterial blood gas analysis. Since there were no indications for other reasons of lactatemia, an acute refeeding syndrome caused by the insulin therapy was suspected. Thiamine and phosphate were thus replaced. With this treatment, lactate values fell, supporting the hypothesis of lactatemia due to substrate deficiency.