Endocrine Abstracts

Background: Lactic acidosis is a common finding in critically ill patients. In patients with poorly controlled diabetes for a prolonged period of time, Glycogenic hepatopathy (GH), can cause lactic acidosis which is a rare condition that develops due to excessive accumulation of glycogen in the hepatocytes.

Cases: Two cases with poorly controlled diabetes and glycogenic hepatopathy are presented. First patient was a 28 year old female with 20 year history of diabetes, HbA1c of 77 mmol/mol, BMI 24.1 kg/m², 4 admissions with DKA in last 12 months; was admitted with lactic acid of 3.0 mmol/l. On presentation, labs showed Glucose 37.1 mmol/l, H+ 114 nmol/l, HCO3 3 mmol/l. She was treated for DKA which resolved in 34 hours. Lactate peaked at 7.4 mmol/l. Ultrasound showed hepatomegaly with normal LFTs apart from ALP of 163 U/l. Second case was another 28 year old with a 17 year history of diabetes, HbA1c of 118 mmol/mol, BMI 23.6 kg/m², 3 admissions with DKA in last 12 months; was admitted with lactic acid of 2.7 mmol/l. On presentation, labs showed H+ 88 nmol/l, HCO3 6 mmol/l, Glucose 41.6 mmol/l. She was treated for DKA which resolved in 29 hours. Lactate peaked at 5.5 mmol/l. Ultrasound showed hepatomegaly (19.5cm) with normal LFTs apart from ALP of 153 U/l. Basal bolus insulin regimen was continued and biopsy was not permed in either of the cases.

Discussion: In these 2 patients with history of poorly controlled diabetes and hepatomegaly on ultrasound, lactate levels continued to rise during and after resolution of the DKA, with GH likely cause of the hepatomegaly. It is important to differentiate it from NAFLD as it does not progress to cirrhosis and can improve with better glycemic control.