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Xu X, Xu R, Hou S, Kang Z, Lü C, Wang Q, Zhang W, Wang X, Xu P, Gao C, Ma C. A Selective Fluorescent l-Lactate Biosensor Based on an l-Lactate-Specific Transcription Regulator and Förster Resonance Energy Transfer. BIOSENSORS 2022; 12:1111. [PMID: 36551077 PMCID: PMC9775004 DOI: 10.3390/bios12121111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Selective detection of l-lactate levels in foods, clinical, and bacterial fermentation samples has drawn intensive attention. Many fluorescent biosensors based on non-stereoselective recognition elements have been developed for lactate detection. Herein, the allosteric transcription factor STLldR from Salmonella enterica serovar Typhimurium LT2 was identified to be stereo-selectively respond to l-lactate. Then, STLldR was combined with Förster resonance energy transfer (FRET) to construct a fluorescent l-lactate biosensor FILLac. FILLac was further optimized by truncating the N- and C-terminal amino acids of STLldR between cyan and yellow fluorescent proteins. The optimized biosensor FILLac10N0C exhibited a maximum emission ratio change (ΔRmax) of 33.47 ± 1.91%, an apparent dissociation constant (Kd) of 6.33 ± 0.79 μM, and a limit of detection of 0.68 μM. FILLac10N0C was applied in 96-well microplates to detect l-lactate in bacterial fermentation samples and commercial foods such as Jiaosu and yogurt. The quantitation results of FILLac10N0C exhibited good agreement with that of a commercial l-lactate biosensor SBA-40D bioanalyzer. Thus, the biosensor FILLac10N0C compatible with high-throughput detection may be a potential choice for quantitation of l-lactate in different biological samples.
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Affiliation(s)
- Xianzhi Xu
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao 266237, China
| | - Rong Xu
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao 266237, China
| | - Shuang Hou
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao 266237, China
| | - Zhaoqi Kang
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao 266237, China
| | - Chuanjuan Lü
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao 266237, China
| | - Qian Wang
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao 266237, China
| | - Wen Zhang
- Institute of Medical Sciences, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, China
| | - Xia Wang
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao 266237, China
| | - Ping Xu
- State Key Laboratory of Microbial Metabolism, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Chao Gao
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao 266237, China
| | - Cuiqing Ma
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao 266237, China
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Meléndez DM, Marti S, Faucitano L, Haley DB, Schwinghamer TD, Schwartzkopf-Genswein KS. Correlation between L-Lactate Concentrations in Beef Cattle, Obtained Using a Hand-Held Lactate Analyzer and a Lactate Assay Colorimetric Kit. Animals (Basel) 2021; 11:ani11040926. [PMID: 33806010 PMCID: PMC8064460 DOI: 10.3390/ani11040926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Lactate is a metabolite used in animal research as an indicator of muscle fatigue; therefore, it has been used as an indicator of cattle response to long distance transportation. The aim of this study was to assess the relationship of L-lactate concentrations measured using a Lactate Scout+ hand-held analyzer and a traditional lactate assay colorimetric kit. Blood samples were collected from 96 steers prior to loading and after 36 h of transportation, and prior to reloading and after an additional 4 h of road transportation, and on d 1, 2, 3, 5, 14, and 28 after transport. The Lactate Scout+ hand-held analyzer strip was dipped in blood at the time of sampling, while blood samples were collected into sodium fluoride tubes for use in the colorimetric analysis. Correlations were calculated to assess the strength of the relationship between the L-lactate concentrations measured between methods. The strength of the correlation and the level of statistical significance varied over the observed time points, while the correlation for the pooled data was weak. Based on the low strength of the correlation, the Lactate Scout+ analyzer is not a suitable alternative to a colorimetric assay for measuring L-lactate in transported cattle. Abstract Lactate is a product of anaerobic glycolysis, used in animal research as an indicator of muscle fatigue. Therefore, it has been used as an indicator of cattle response to long distance transportation. The aim of this study was to assess the relationship of L-lactate concentrations measured using a Lactate Scout+ analyzer and a traditional lactate assay colorimetric kit. Blood samples were collected by venipuncture from 96 steers (Black or Red Angus × Hereford/Simmental and Black or Red Angus × Charolais; 247 ± 38.2 kg BW) prior to loading (LO1) and after 36 h of transport, and prior to reloading and after an additional 4 h of road transportation, and on d 1, 2, 3, 5, 14, and 28 after transport. The Lactate Scout+ analyzer strip was dipped in blood at the time of sampling, while blood samples were collected into sodium fluoride tubes for use in the colorimetric analysis. Pearson correlations were calculated to assess the strength of the relationship between the experimental methods for the quantification of L-lactate concentrations. The magnitude and direction of the correlation, and the level of statistical significance varied over the observed time points, ranging from r = −0.03 (p = 0.75; LO1) to r = 0.75 (p < 0.0001; d 3). The correlation for the pooled data was weak but statistically significant (r = 0.33, p < 0.0001). Based on the low magnitude of the correlation due to variability across sampling time points in this study, the Lactate Scout+ analyzer is not a suitable alternative to a lab-based assay (considered the gold standard) for measuring L-lactate in transported cattle.
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Affiliation(s)
- Daniela M. Meléndez
- Agriculture and Agri-Food Canada, Lethbridge Research and Development Centre, Lethbridge, AB T1J 4B1, Canada; (D.M.M.); (T.D.S.)
| | - Sonia Marti
- IRTA Ruminant Production Program, Caldes de Montbui, 08140 Barcelona, Spain;
| | - Luigi Faucitano
- Agriculture and Agri-Food Canada, Sherbrooke Research and Development Centre, Sherbrooke, QC J1M 0C8, Canada;
| | - Derek B. Haley
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Timothy D. Schwinghamer
- Agriculture and Agri-Food Canada, Lethbridge Research and Development Centre, Lethbridge, AB T1J 4B1, Canada; (D.M.M.); (T.D.S.)
| | - Karen S. Schwartzkopf-Genswein
- Agriculture and Agri-Food Canada, Lethbridge Research and Development Centre, Lethbridge, AB T1J 4B1, Canada; (D.M.M.); (T.D.S.)
- Correspondence:
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Baishya N, Budidha K, Mamouei M, Qassem M, Vadgama P, Kyriacou PA. Near Infrared Spectrometric Investigations on the behaviour of Lactate. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:5769-5772. [PMID: 31947163 DOI: 10.1109/embc.2019.8857833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In patients with life-threatening illnesses, the metabolic production and disposal of lactate are impaired, which leads to a build-up of blood lactate. In critical care units, the changes in lactate levels are measured through intermittent, invasive, blood sampling and in vitro assay. Continuous monitoring is lacking, yet such monitoring could allow early assessment of severity and prognosis to guide therapy. Currently, there is no routine means to measure lactate levels continuously, particularly non-invasively. The motivation of this study was to understand the interaction of lactate with light in the Near Infra Red (NIR) region of the electromagnetic spectrum. This was to create an opportunity to explore the possibility of a non-invasive sensing technology to monitor lactate continuously.In vitro studies were performed using solution samples with varying concentration levels of sodium lactate in isotonic Phosphate Buffer Solution (PBS) at constant pH (7.4). These samples were prepared using stoichiometric solution compositions and spectra for each sample were taken using a state-of-the-art spectrometer in the NIR region. The spectra were then analysed qualitatively by 2D correlation analysis, which identified the regions of interest. Further analysis of these regions using linear regression at four randomly selected wavelengths showed bathochromic shifts, which, moreover, showed systematic variation correlating with lactate concentration.
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Rosenstein PG, Tennent-Brown BS, Hughes D. Clinical use of plasma lactate concentration. Part 1: Physiology, pathophysiology, and measurement. J Vet Emerg Crit Care (San Antonio) 2018. [PMID: 29533512 DOI: 10.1111/vec.12708] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review the current literature with respect to the physiology, pathophysiology, and measurement of lactate. DATA SOURCES Data were sourced from veterinary and human clinical trials, retrospective studies, experimental studies, and review articles. Articles were retrieved without date restrictions and were sourced primarily via PubMed, Scopus, and CAB Abstracts as well as by manual selection. HUMAN AND VETERINARY DATA SYNTHESIS Lactate is an important energy storage molecule, the production of which preserves cellular energy production and mitigates the acidosis from ATP hydrolysis. Although the most common cause of hyperlactatemia is inadequate tissue oxygen delivery, hyperlactatemia can, and does occur in the face of apparently adequate oxygen supply. At a cellular level, the pathogenesis of hyperlactatemia varies widely depending on the underlying cause. Microcirculatory dysfunction, mitochondrial dysfunction, and epinephrine-mediated stimulation of Na+ -K+ -ATPase pumps are likely important contributors to hyperlactatemia in critically ill patients. Ultimately, hyperlactatemia is a marker of altered cellular bioenergetics. CONCLUSION The etiology of hyperlactatemia is complex and multifactorial. Understanding the relevant pathophysiology is helpful when characterizing hyperlactatemia in clinical patients.
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Affiliation(s)
- Patricia G Rosenstein
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
| | - Brett S Tennent-Brown
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
| | - Dez Hughes
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
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Mink S, Roy Chowdhury SK, Gotes J, Cheng ZQ, Kasian K, Fernyhough P. Gentisic acid sodium salt, a phenolic compound, is superior to norepinephrine in reversing cardiovascular collapse, hepatic mitochondrial dysfunction and lactic acidemia in Pseudomonas aeruginosa septic shock in dogs. Intensive Care Med Exp 2016; 4:24. [PMID: 27456956 PMCID: PMC4960072 DOI: 10.1186/s40635-016-0095-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/07/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The development of lactic acidemia (LA) in septic shock (SS) is associated with an ominous prognosis. We previously showed that the mechanism of LA in SS may relate to impaired hepatic uptake of lactate, but the mechanism was not clear. Uptake of lactate by the liver occurs by a membrane-associated, pH-dependent, antiport system known as the monocarboxylate transporter. In the hepatocyte, lactate can then be metabolized by oxidative phosphorylation or converted to glucose in the cytosol. In the present study, we examined (1) whether hepatic mitochondrial dysfunction accounted for decreased uptake of lactate in a canine model of Pseudomonas aeruginosa SS, (2) whether norepinephrine (NE) treatment by increasing mean arterial pressure (MAP) could improve mitochondrial dysfunction and LA in this model, and (3) whether gentisic acid sodium salt (GSS), a novel phenolic compound, was superior to NE in these effects. METHODS In anesthetized/ventilated dogs, we infused the bacteria over ~10 h and measured hemodynamics in various treatment groups (see below). We then euthanized the animal and isolated the hepatic mitochondria. We measured hepatic mitochondrial oxygen consumption rates using the novel Seahorse XF24 analyzer under conditions that included: basal respiration, after the addition of adenosine- diphosphate to produce coupled respiration, and after the addition of a protonophore to produce maximal respiration. RESULTS We found that in the septic control group, mean arterial pressure decreased over the course of the study, and that mitochondrial dysfunction developed in which there was a reduction in maximal respiration. Whereas both NE and GSS treatments reversed the reduction in mean arterial pressure and increased maximal respiration to similar extents in respective groups, only in the GSS group was there a reduction in LA. CONCLUSIONS Hepatic mitochondrial dysfunction occurs in SS, but does not appear to be required for the development of LA in SS, since NE improved mitochondrial dysfunction without reversing LA. GSS, a phenolic compound restored mean arterial pressure, mitochondrial dysfunction, and LA in SS. This reduction in LA may be independent of its effect on improving hepatic mitochondrial function.
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Affiliation(s)
- Steven Mink
- Departments of Medicine and Pharmacology and Therapeutics, University of Manitoba, Winnipeg, MB, Canada. .,Health Sciences Centre, GF-221, 820 Sherbrook St, Winnipeg, MB, R3A-1R9, Canada.
| | - Subir K Roy Chowdhury
- Division of Neurodegenerative Disorders at the St. Boniface Hospital Research Centre, Winnipeg, MB, Canada
| | - Jose Gotes
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.,Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Zhao-Qin Cheng
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Krika Kasian
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Fernyhough
- Division of Neurodegenerative Disorders at the St. Boniface Hospital Research Centre, Winnipeg, MB, Canada.,Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg, Manitoba, Canada
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Ardiaca M, Dias S, Montesinos A, Bonvehi C, Barrera S, Cuesta M. Plasmaticl-lactate in pet rabbits: association with morbidity and mortality at 14 days. Vet Clin Pathol 2016; 45:116-23. [DOI: 10.1111/vcp.12308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Sara Dias
- Centro Veterinario Los Sauces; Madrid Spain
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Tynan B, Kerl ME, Jackson ML, Mann FA. Plasma lactate concentrations and comparison of two point-of-care lactate analyzers to a laboratory analyzer in a population of healthy cats. J Vet Emerg Crit Care (San Antonio) 2015; 25:521-7. [PMID: 26088563 DOI: 10.1111/vec.12321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 12/20/2013] [Accepted: 03/22/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To establish a reference interval for plasma lactate in a population of healthy adult cats on a laboratory analyzer (Nova Biomedical Critical Care Xpress [CCX]) and 2 commercially available point-of-care (POC) analyzers (Abbott i-STAT [i-STAT] and Nova Biomedical Lactate Plus [LP]), and to compare the level of agreement of lactate measurement between the laboratory analyzer and POC analyzers. DESIGN Prospective observational study. SETTING University veterinary teaching hospital. ANIMALS Forty-seven healthy adult cats. INTERVENTIONS Jugular phlebotomy. MEASUREMENTS AND MAIN RESULTS In this population, plasma lactate reference interval was 0.67-5.44 mmol/L for the CCX, 0.65-5.16 mmol/L for the i-STAT, and 0.68-4.39 mmol/L for the LP. Comparisons were made between lactate measurements on 2 point-of-care analyzers and the laboratory analyzer using the Bland-Altman method. For the comparison of CCX and i-STAT, the bias was -0.10 mmol/L; for the CCX and LP, the bias was -0.24 mmol/L. CONCLUSIONS Measurements of plasma lactate in cats using the i-STAT showed acceptable agreement with the CCX. The LP showed weaker agreement. However, both POC analyzers are suitable for measurement of lactate in cats, provided results from different POC analyzers are not directly compared. This study identified a larger reference interval for plasma lactate concentration in cats than what has been previously reported.
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Affiliation(s)
- Beth Tynan
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, 900 East Campus Drive, Columbia, MO, 65211
| | - Marie E Kerl
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, 900 East Campus Drive, Columbia, MO, 65211
| | - Mary L Jackson
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, 900 East Campus Drive, Columbia, MO, 65211
| | - F A Mann
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, 900 East Campus Drive, Columbia, MO, 65211
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Mooney E, Raw C, Hughes D. Plasma lactate concentration as a prognostic biomarker in dogs with gastric dilation and volvulus. Top Companion Anim Med 2014; 29:71-6. [PMID: 25496924 DOI: 10.1053/j.tcam.2014.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Initial and serial plasma lactate concentrations can be used to guide decision making in individual dogs with GDV but care is necessary in phrasing conversations with owners. Published data suggests that survival is more likely and the chance of complications less in dogs with an initial plasma lactate of <4 mmol/L. An initial lactate >6 mmol/L makes gastric necrosis and greater expense more likely. However, because of the overlap between groups and the good overall survival rates, exploratory laparotomy should always be recommended irrespective of the plasma lactate concentration. Falls in plasma lactate of greater than ~40% after fluid resuscitation are likely to indicate better survival. If the initial plasma lactate concentration is moderately to severely increased (5->10 mmol/L) and a sustained increase in plasma lactate occurs after fluid resuscitation, the cause should be aggressively pursued. Many dogs with persistent hyperlactatemia over 24-48 hours do not survive.
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Affiliation(s)
- Erin Mooney
- Small Animal Specialist Hospital, New South Wales, Australia
| | - Cameron Raw
- Rochester Veterinary Practice, Victoria, Australia
| | - Dez Hughes
- Section of Emergency and Critical Care, Veterinary Hospital, University of Melbourne, Victoria, Australia.
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Tennent-Brown B. Blood lactate measurement and interpretation in critically ill equine adults and neonates. Vet Clin North Am Equine Pract 2014; 30:399-413, viii. [PMID: 25016498 DOI: 10.1016/j.cveq.2014.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Admission blood lactate concentration is widely used as a prognostic indicator in equine medicine and can be a useful indicator of disease severity but typically fails to completely discriminate survivors from nonsurvivors. Increased admission lactate concentrations in adult horses typically return to normal within 12 to 24 hours. Lactate concentrations in neonatal foals are higher than adult concentrations for the first 24 to 72 hours of life. Serial measures reflecting both the magnitude and duration of hyperlactatemia might enable more accurate prognostication and provide insight into disease pathogenesis and could be a valuable therapeutic guide.
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Affiliation(s)
- Brett Tennent-Brown
- Faculty of Veterinary Science, Equine Centre, The University of Melbourne, 250 Princess Highway, Werribee, Victoria 3030, Australia.
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Different contribution of splanchnic organs to hyperlactatemia in fecal peritonitis and cardiac tamponade. BIOMED RESEARCH INTERNATIONAL 2013; 2013:251084. [PMID: 24228242 PMCID: PMC3817825 DOI: 10.1155/2013/251084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/27/2013] [Accepted: 09/01/2013] [Indexed: 11/17/2022]
Abstract
Background. Changes in hepatosplanchnic lactate exchange are likely to contribute to hyperlactatemia in sepsis. We hypothesized that septic and cardiogenic shock have different effects on hepatosplanchnic lactate exchange and its contribution to hyperlactatemia. Materials and Methods. 24 anesthetized pigs were randomized to fecal peritonitis (P), cardiac tamponade (CT), and to controls (n = 8 per group). Oxygen transport and lactate exchange were calculated during 24 hours. Results. While hepatic lactate influx increased in P and in CT, hepatic lactate uptake remained unchanged in P and decreased in CT. Hepatic lactate efflux contributed 20% (P) and 33% (CT), respectively, to whole body venous efflux. Despite maintained hepatic arterial blood flow, hepatic oxygen extraction did not increase in CT. Conclusions. Whole body venous lactate efflux is of similar magnitude in hyperdynamic sepsis and in cardiogenic shock. Although jejunal mucosal pCO2 gradients are increased, enhanced lactate production from other tissues is more relevant to the increased arterial lactate. Nevertheless, the liver fails to increase hepatic lactate extraction in response to rising hepatic lactate influx, despite maintained hepatic oxygen consumption. In cardiac tamponade, regional, extrasplanchnic lactate production is accompanied by hepatic failure to increase oxygen extraction and net hepatic lactate output, despite maintained hepatic arterial perfusion.
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Valenza F, Pizzocri M, Salice V, Chevallard G, Fossali T, Coppola S, Froio S, Polli F, Gatti S, Fortunato F, Comi GP, Gattinoni L. Sodium bicarbonate treatment during transient or sustained lactic acidemia in normoxic and normotensive rats. PLoS One 2012; 7:e46035. [PMID: 23029373 PMCID: PMC3461035 DOI: 10.1371/journal.pone.0046035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 08/28/2012] [Indexed: 11/30/2022] Open
Abstract
Introduction Lactic acidosis is a frequent cause of poor outcome in the intensive care settings. We set up an experimental model of lactic acid infusion in normoxic and normotensive rats to investigate the systemic effects of lactic acidemia per se without the confounding factor of an underlying organic cause of acidosis. Methodology Sprague Dawley rats underwent a primed endovenous infusion of L(+) lactic acid during general anesthesia. Normoxic and normotensive animals were then randomized to the following study groups (n = 8 per group): S) sustained infusion of lactic acid, S+B) sustained infusion+sodium bicarbonate, T) transient infusion, T+B transient infusion+sodium bicarbonate. Hemodynamic, respiratory and acid-base parameters were measured over time. Lactate pharmacokinetics and muscle phosphofructokinase enzyme's activity were also measured. Principal Findings Following lactic acid infusion blood lactate rose (P<0.05), pH (P<0.05) and strong ion difference (P<0.05) drop. Some rats developed hemodynamic instability during the primed infusion of lactic acid. In the normoxic and normotensive animals bicarbonate treatment normalized pH during sustained infusion of lactic acid (from 7.22±0.02 to 7.36±0.04, P<0.05) while overshoot to alkalemic values when the infusion was transient (from 7.24±0.01 to 7.53±0.03, P<0.05). When acid load was interrupted bicarbonate infusion affected lactate wash-out kinetics (P<0.05) so that blood lactate was higher (2.9±1 mmol/l vs. 1.0±0.2, P<0.05, group T vs. T+B respectively). The activity of phosphofructokinase enzyme was correlated with blood pH (R2 = 0.475, P<0.05). Conclusions pH decreased with acid infusion and rose with bicarbonate administration but the effects of bicarbonate infusion on pH differed under a persistent or transient acid load. Alkalization affected the rate of lactate disposal during the transient acid load.
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Affiliation(s)
- Franco Valenza
- Dipartimento di Anestesia, Rianimazione e Terapia del Dolore, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
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Cerdá J, Tolwani AJ, Warnock DG. Critical care nephrology: management of acid–base disorders with CRRT. Kidney Int 2012; 82:9-18. [DOI: 10.1038/ki.2011.243] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Vitin A, Muczynski K, Bakthavatsalam R, Martay K, Dembo G, Metzner J. Treatment of severe lactic acidosis during the pre-anhepatic stage of liver transplant surgery with intraoperative hemodialysis. J Clin Anesth 2010; 22:466-72. [DOI: 10.1016/j.jclinane.2009.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Revised: 06/23/2009] [Accepted: 07/04/2009] [Indexed: 01/30/2023]
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Taurà P, Fuster J, Mercadal J, Martinez-Palli G, Fondevila C, Blasi A, Balust J, Garcia-Valdecasas JC. The use of beta-adrenergic drugs improves hepatic oxygen metabolism in cirrhotic patients undergoing liver resection. J Hepatol 2010; 52:340-7. [PMID: 20137821 DOI: 10.1016/j.jhep.2009.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 08/30/2009] [Accepted: 09/24/2009] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS Hepatic resection is associated with hemodynamic and oxygen metabolism disturbances of the residual liver resulting from liver regeneration. In underlying liver disease, the remnant liver responds inadequately to increased energy demands leading to a less efficient recovery process. The aim of this study was to assess the effect of vasoactive drugs on hepatic oxygen metabolism and hemodynamics in cirrhotic patients that have undergone liver resection. METHODS Thirty patients were randomly allocated to receive peri-operatively low doses (4 microg/kg/min) of dopamine (DaG, n=10), dobutamine (DbG, n=10) or saline (CG, n=10). Hepatic hemodynamics, hepatic oxygen metabolism and lactate uptakes were evaluated before drug administration and at the time of abdominal closure. Post-operative liver function and outcome were recorded. RESULTS The peri-operative use of vasoactive drugs preserved total hepatic blood flow and hepatic compliance, even increasing in patients who received Db, whereas those parameters decreased in CG after liver resection. At this time, oxygen delivery and consumption decreased in CG patients, but were unchanged when vasoactive drugs were used. In all groups, lactate uptake decreased sharply and only DbG showed positive lactate extraction capacity. The peak of post-operative bilirubin, which resumed baseline values more quickly in DbG, inversely correlated with intra-operative hepatic compliance and hepatic oxygen extraction. CONCLUSION Low doses of vasoactive drugs, especially dobutamine, improved hepatic oxygen supply and uptake preserving immediate function of the remnant cirrhotic liver.
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Affiliation(s)
- Pilar Taurà
- Department of Anesthesiology, Liver Surgery and Liver Transplant Unit, Hospital Clinic, Villarroel 170, Barcelona University, Barcelona, Spain.
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Venous blood lactate evaluation in equine neonatal intensive care. Theriogenology 2010; 73:343-57. [DOI: 10.1016/j.theriogenology.2009.09.018] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 09/17/2009] [Accepted: 09/27/2009] [Indexed: 11/23/2022]
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Corley KTT, Donaldson LL, Furr MO. Arterial lactate concentration, hospital survival, sepsis and SIRS in critically ill neonatal foals. Equine Vet J 2010; 37:53-9. [PMID: 15651735 DOI: 10.2746/0425164054406856] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
REASONS FOR PERFORMING STUDY Blood lactate concentration has been shown to be a useful clinical indicator in human patients, but has not been formally investigated in critically ill foals. OBJECTIVE To investigate the association of blood lactate with hospital survival, markers of cardiovascular status, metabolic acid base status, sepsis and systemic inflammatory response syndrome (SIRS). METHODS A database containing clinical, haematological, plasma biochemical and hospital outcome data on neonatal foals referred to an intensive care unit in 2000-2001 was analysed. Seventy-two foals for which arterial lactate was measured at admission were included in the study. RESULTS Sixty-one foals had an admission lactate concentration > 2.5 mmol/l. Admission lactate was statistically associated with hospital survival, mean arterial pressure, blood creatinine concentration, bacteraemia, anion gap, lactate concentration at 18-36 h after admission and evidence of SIRS, but not with packed cell volume or heart rate. Lactate at 18-36 h was also associated with survival and evidence of SIRS. Anion gap, base excess, base excess due to unidentified anions (BEua), simplified strong ion gap or bicarbonate correctly classified foals for presence of hyperlactaemia (> 5 mmol/l) in < or = 80% of animals. CONCLUSIONS Admission blood lactate gives important prognostic information. Lactate should be measured rather than assumed from the anion gap, base excess, BEua, simplified strong ion gap or bicarbonate. POTENTIAL RELEVANCE Blood lactate concentrations at admission are clinically relevant in neonatal foals and warrant further investigation. This should include the clinical value of measuring changes in lactate in response to treatment.
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Affiliation(s)
- K T T Corley
- Equine Referral Hospital, Royal Veterinary College, North Mymms, Hertfordshire AL9 7TA, UK
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Blood lactate monitoring in critically ill patients: a systematic health technology assessment. Crit Care Med 2009; 37:2827-39. [PMID: 19707124 DOI: 10.1097/ccm.0b013e3181a98899] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To decide whether the use of blood lactate monitoring in critical care practice is appropriate. We performed a systematic health technology assessment as blood lactate monitoring has been implemented widely but its clinical value in critically ill patients has never been evaluated properly. DATA SOURCE PubMed, other databases, and citation review. STUDY SELECTION We searched for lactate combined with critically ill patients as the target patient population. Two reviewers independently selected studies based on relevance for the following questions: Does lactate measurement: 1) perform well in a laboratory setting? 2) provide information in a number of clinical situations? 3) relate to metabolic acidosis? 4) increase workers' confidence? 5) alter therapeutic decisions? 6) result in benefit to patients? 7) result in similar benefits in your own setting? 8) result in benefits which are worth the extra costs? DATA EXTRACTION AND SYNTHESIS We concluded that blood lactate measurement in critically ill patients: 1) is accurate in terms of measurement technique but adequate understanding of the (an)aerobic etiology is required for its correct interpretation; 2) provides not only diagnostic but also important prognostic information; 3) should be measured directly instead of estimated from other acid-base variables; 4) has an unknown effect on healthcare workers' confidence; 5) can alter therapeutic decisions; 6) could potentially improve patient outcome when combined with a treatment algorithm to optimize oxygen delivery, but this has only been shown indirectly; 7) is likely to have similar benefits in critical care settings worldwide; and 8) has an unknown cost-effectiveness. CONCLUSIONS The use of blood lactate monitoring has a place in risk-stratification in critically ill patients, but it is unknown whether the routine use of lactate as a resuscitation end point improves outcome. This warrants randomized controlled studies on the efficacy of lactate-directed therapy.
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Inotropic Support During Experimental Endotoxemic Shock: Part II. A Comparison of Levosimendan with Dobutamine. Anesth Analg 2009; 109:1576-83. [DOI: 10.1213/ane.0b013e3181af40e0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Blood lactate monitoring in critically ill patients: A systematic health technology assessment *. Crit Care Med 2009. [DOI: 10.1097/00003246-200910000-00022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wotman K, Wilkins P, Palmer J, Boston R. Association of Blood Lactate Concentration and Outcome in Foals. J Vet Intern Med 2009; 23:598-605. [DOI: 10.1111/j.1939-1676.2009.0277.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Hagman R, Reezigt BJ, Bergström Ledin H, Karlstam E. Blood lactate levels in 31 female dogs with pyometra. Acta Vet Scand 2009; 51:2. [PMID: 19134167 PMCID: PMC2630309 DOI: 10.1186/1751-0147-51-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 01/09/2009] [Indexed: 11/10/2022] Open
Abstract
Background Canine pyometra is a life-threatening disease common in countries where spaying of dogs is not routinely performed. The disease is associated with endotoxemia, sepsis, systemic inflammatory response syndrome (SIRS) and a 3–4% mortality rate. Blood lactate analysis is clinically valuable in predicting prognosis and survival, evaluating tissue perfusion and treatment response in human and veterinary critical care settings. The aims of the present study were to investigate 1) the blood lactate levels of female dogs with pyometra by a hand-held analyser and 2) if these levels are related with the clinical status or other biochemical or hematological disorders. Methods In total 31 female dogs with pyometra admitted for surgical ovariohysterectomy and 16 healthy female control dogs were included in the present study. A complete physical examination including SIRS-status determination was performed. Blood samples for lactate concentrations, hematological and biochemical parameters, acid-base and blood gas analysis and other laboratory parameters were collected and subsequently analysed. The diagnosis pyometra was verified with histopathological examination of the uterus and ovaries. Increased hospitalisation length and presence of SIRS were used as indicators of outcome. Results In the pyometra group the median blood lactate level was 1,6 mmol l-1 (range <0.8–2.7 mmol l-1). In the control group the median lactate level was 1,2 mmol l-1 (range <0.8–2.1 mmol l-1). Of the 31 bitches 19 (61%) fulfilled 2 or more criteria for SIRS at inclusion, 10 bitches (32%) fulfilled 3 of the SIRS criteria whereas none accomplished more than 3 criteria. Lactate levels did not differ significantly between the pyometra and control group, or between the SIRS positive and SIRS negative dogs with pyometra. Increased lactate concentration (>2.5 mmol l-1) was demonstrated in one female dog with pyometra (3%), and was not associated with longer hospitalisation or presence of SIRS. Lactate measurement was not indicative of peritonitis. None of the bitches died during or within two months of the hospital stay. The measurements of temperature, heart rate, respiratory rate, percentage bandforms of neutrophilic granulocytes, α2-globulins, creatinin, pvCO2, TCO2 and base excess showed significant differences between the SIRS positive and the SIRS negative pyometra cases. Conclusion Increased blood lactate concentrations were demonstrated in 3% (1/31), and SIRS was present in 61% (19/31) of the female dogs with pyometra. Preoperative lactate levels were not related with presence of SIRS or prolonged hospitalisation. Lactate measurement was not indicative of peritonitis. The value of a single and repeated lactate analysis in more severely affected cases remains to be determined.
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Abstract
PURPOSE OF REVIEW Bicarbonate therapy for severe lactic acidosis remains a controversial therapy. RECENT FINDINGS The most recent 2008 Surviving Sepsis guidelines strongly recommend against the use of bicarbonate in patients with pH at least 7.15, while deferring judgment in more severe acidemia. We review the mechanisms causing lactic acidosis in the critically ill and the scientific rationale behind treatment with bicarbonate. SUMMARY There is little rationale or evidence for the use of bicarbonate therapy for lactic acidosis due to shock. We agree with the Surviving Sepsis guidelines recommendation against the use of bicarbonate for lactic acidosis for pH at least 7.15 and we further recommend a lower target pH of 7.00 or less. If bicarbonate is used, consideration must be given to slow infusion and a plan for clearing the CO2 that is produced and measuring and correcting ionized calcium as the resultant 10% drop may decrease cardiac and vascular contractility and responsiveness to catecholamines. When continuous renal replacement therapy is used during severe acidosis, we recommend bicarbonate-based replacement fluid over citrate as citrate may increase the strong ion gap. Effective therapy of lactic acidosis due to shock is to reverse the cause.
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Mink SN, Kasian K, Jacobs H, Cheng ZQ, Light RB. N,N′-DIACETYLCHITOBIOSE, AN INHIBITOR OF LYSOZYME, REVERSES MYOCARDIAL DEPRESSION AND LESSENS NOREPINEPHRINE REQUIREMENTS IN ESCHERICHIA COLI SEPSIS IN DOGS. Shock 2008; 29:681-7. [PMID: 17885642 DOI: 10.1097/shk.0b013e31815816c3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cardiovascular dysfunction in septic shock (SS) is ascribed to the release of inflammatory mediators. Norepinephrine (NE) is often administered to treat low MAP in SS. We recently found that lysozyme c (Lzm-S) released from leukocytes was a mediator of myocardial depression in an Escherichia coil model of SS in dogs. This effect can be blocked in an in vitro preparation by chitobiose, a competitive inhibitor of Lzm-S. In the present study, we examined whether chitobiose treatment can reverse myocardial depression and obviate NE requirements in two respective canine E. coli preparations. In a 6-h study, we administered chitobiose after 3.5 h of E. coli bacteremia and compared stroke work (SW) and MAP at 6 h with a sepsis control group. In a 12-h study, we determined whether chitobiose treatment can reduce the need for NE requirements during 12 h of bacteremia. In the latter study, either chitobiose or NE was given when MAP decreased approximately 20% from the presepsis value in respective groups. In anesthetized, mechanically ventilated dogs, we monitored hemodynamic parameters during continuous E. coli infusion. In the 6-h study, chitobiose improved SW and MAP at the 6-h period as compared with the nontreated sepsis group. In the 12-h study, SW and MAP increased after chitobiose without the necessity of NE administration. These results suggest that inhibitors of Lzm-S such as chitobiose may improve myocardial depression and reduce the need for NE requirements in SS.
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Affiliation(s)
- Steven N Mink
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
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Tennent-Brown BS, Wilkins PA, Lindborg S, Russell G, Boston RC. Assessment of a Point-of-Care Lactate Monitor in Emergency Admissions of Adult Horses to a Referral Hospital. J Vet Intern Med 2007. [DOI: 10.1111/j.1939-1676.2007.tb03069.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kadoi Y, Goto F. Effects of AM281, a cannabinoid antagonist, on circulatory deterioration and cytokine production in an endotoxin shock model: comparison with norepinephrine. J Anesth 2007; 20:284-9. [PMID: 17072693 DOI: 10.1007/s00540-006-0428-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Accepted: 07/04/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to examine the comparative effects of AM281, a cannabinoid antagonist, and norepinephrine (NE) on systemic hemodynamics, and renal and mesenteric artery blood flow in an endotoxin shock model. METHODS The study was designed to include two sets of experiments: (1) measurements of changes in systemic hemodynamics and organ artery blood flows (n = 20), and (2) measurements of biochemical variables (n = 20). For each set of experiments, male 7-week-old Wistar rats were randomly divided into four groups: group 1, controls (n = 5); group 2, receiving lipopolysaccharide (LPS: Escherichia coli endotoxin, 10.0 mg.kg(-1) intravenous bolus) (n = 5); group 3, receiving intravenous LPS and NE (continuous infusion at 0.2 microg.kg.min(-1)) (n = 5); group 4, receiving LPS and AM281 (0.1 mg.kg.min(-1)) (n = 5). Systemic hemodynamics, regional artery blood flow changes, and biochemical variables were assessed before treatment and 1 and 3 h after treatment. RESULTS Infusion of NE or AM281 prevented endotoxin-induced decreases in systemic arterial pressure, aortic blood flow, carotid artery blood flow, and renal artery blood flow. Both AM281 and NE inhibited endotoxin-induced increases in cytokine production, with significant differences observed among the three groups at 1 and 3 h after treatment. Endotoxin-induced decreases in mesenteric arterial blood flow were restored by AM281 but not by NE. AM281 improved arterial oxygenation and reduced lactate overproduction and body temperature elevation induced by endotoxin. CONCLUSIONS Although NE and AM281 both prevented endotoxin-induced deterioration of systemic hemodynamics, AM281 yielded better preservation of mesenteric blood flow and attenuation of cytokine production than NE.
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Affiliation(s)
- Yuji Kadoi
- Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan
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Forni LG, McKinnon W, Hilton PJ. Unmeasured anions in metabolic acidosis: unravelling the mystery. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2006; 10:220. [PMID: 16879718 PMCID: PMC1750972 DOI: 10.1186/cc4954] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In the critically ill, metabolic acidosis is a common observation and, in clinical practice, the cause of this derangement is often multi-factorial. Various measures are often employed to try and characterise the aetiology of metabolic acidosis, the most popular of which is the anion gap. The purpose of the anion gap can be perceived as a means by which the physician is alerted to the presence of unmeasured anions in plasma that contribute to the observed acidosis. In many cases, the causative ion may be easily identified, such as lactate, but often the causative ion(s) remain unidentified, even after exclusion of the 'classic' causes. We describe here the various attempts in the literature that have been made to address this observation and highlight recent studies that reveal potential sources of such hitherto unmeasured anions.
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Affiliation(s)
- Lui G Forni
- Department of Critical Care, Worthing Hospital, Worthing, West Sussex BN11 2DH, UK.
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Abstract
Lactic acidosis is frequently encountered in the intensive care unit. It occurs when there is an imbalance between production and clearance of lactate. Although lactic acidosis is often associated with a high anion gap and is generally defined as a lactate level >5 mmol/L and a serum pH <7.35, the presence of hypoalbuminemia may mask the anion gap and concomitant alkalosis may raise the pH. The causes of lactic acidosis are traditionally divided into impaired tissue oxygenation (Type A) and disorders in which tissue oxygenation is maintained (Type B). Lactate level is often used as a prognostic indicator and may be predictive of a favorable outcome if it normalizes within 48 hours. The routine measurement of serum lactate, however, should not determine therapeutic interventions. Unfortunately, treatment options remain limited and should be aimed at discontinuation of any offending drugs, treatment of the underlying pathology, and maintenance of organ perfusion. The mainstay of therapy of lactic acidosis remains prevention.
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Affiliation(s)
- Pamela J Fall
- Section of Nephrology, Hypertension and Transplantation, Department of Medicine, Medical College of Georgia, Augusta 30912, USA
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Abstract
Infection leads to profound alterations in whole-body metabolism, which is characterized by marked acceleration of glucose, fat and protein, and amino acid flux. One of the complications of infection, especially in the nutritionally supported setting, is hyperglycemia. The hyperglycemia is caused by peripheral insulin resistance and alterations in hepatic glucose metabolism. The defects in hepatic glucose metabolism include overproduction of glucose and a failure of the liver to appropriately adapt when nutritional support is administered. Investigators have suggested that multiple factors contribute to the observed defects. In this review, I focus primarily on alterations in carbohydrate metabolism, examining both the metabolic response to infection and inflammatory stress, the role of the accompanying neuroendocrine and inflammatory responses in the metabolic response, and the interaction between the endocrine response to infection and nutritional support.
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Affiliation(s)
- Owen P McGuinness
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-0615, USA.
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Valenza F, Aletti G, Fossali T, Chevallard G, Sacconi F, Irace M, Gattinoni L. Lactate as a marker of energy failure in critically ill patients: hypothesis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2005; 9:588-93. [PMID: 16356243 PMCID: PMC1414013 DOI: 10.1186/cc3818] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Lactate measurement in the critically ill has been traditionally used to stratify patients with poor outcome. However, plasma lactate levels are the result of a finely tuned interplay of factors that affect the balance between its production and its clearance. When the oxygen supply does not match its consumption, organisms such as man who are forced to produce ATP for their integrity adapt in many different ways up to the point when energy failure occurs. Lactate, being part of the adaptive response, may then be used to assess the severity of the supply/demand imbalance. In such a scenario, the time to intervention becomes relevant: early and effective treatment may allow the cell to revert to a normal state, as long as the oxygen machinery (i.e. mithocondria) is intact. Conversely, once the mithocondria are deranged, energy failure occurs even in the presence of normoxia. The lactate increase in critically ill patients may therefore be viewed as an early marker of a potentially reversible state.
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Affiliation(s)
- Franco Valenza
- Istituto di Anestesia e Rianimazione, Università degli Studi di Milano, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena – Fondazione IRCCS di Natura Pubblica, Milan, Italy
| | - Gabriele Aletti
- Istituto di Anestesia e Rianimazione, Università degli Studi di Milano, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena – Fondazione IRCCS di Natura Pubblica, Milan, Italy
| | - Tommaso Fossali
- Istituto di Anestesia e Rianimazione, Università degli Studi di Milano, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena – Fondazione IRCCS di Natura Pubblica, Milan, Italy
| | - Giorgio Chevallard
- Istituto di Anestesia e Rianimazione, Università degli Studi di Milano, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena – Fondazione IRCCS di Natura Pubblica, Milan, Italy
| | - Francesca Sacconi
- Istituto di Anestesia e Rianimazione, Università degli Studi di Milano, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena – Fondazione IRCCS di Natura Pubblica, Milan, Italy
| | - Manuela Irace
- Istituto di Anestesia e Rianimazione, Università degli Studi di Milano, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena – Fondazione IRCCS di Natura Pubblica, Milan, Italy
| | - Luciano Gattinoni
- Istituto di Anestesia e Rianimazione, Università degli Studi di Milano, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena – Fondazione IRCCS di Natura Pubblica, Milan, Italy
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Corley KTT, Axon JE. Resuscitation and Emergency Management for Neonatal Foals. Vet Clin North Am Equine Pract 2005; 21:431-55, vii. [PMID: 16051057 DOI: 10.1016/j.cveq.2005.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Early intervention can dramatically alter outcome in foals. Cardio-pulmonary cerebral resuscitation can be successful and clinically worthwhile when applied to foals that arrest as part of the birthing process. Readily available equipment and an ordered plan starting with addressing the respiratory system (airway and breathing) followed by the circulatory system (circulation and drugs) are the keys to success. Hypoglycemia is common in foals that are not nursing and in septic foals. Support of serum glucose can be an important emergency treatment. Respiratory support with oxygen therapy should be considered in all foals following resuscitation and dystocia. Other foals that are likely to benefit from oxygen are those that are dyspneic, cyanotic, meconium-stained after birth,or recumbent. Emergency therapies, applied correctly, are expected to result in decreased mortality and morbidity.
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Affiliation(s)
- Kevin T T Corley
- Equine Referral Hospital, Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire AL9 7TA, UK.
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Contaldo C, Plock J, Djonov V, Leunig M, Banic A, Erni D. The Influence of Trauma and Ischemia on Carbohydrate Metabolites Monitored in Hamster Flap Tissue. Anesth Analg 2005; 100:817-822. [PMID: 15728073 DOI: 10.1213/01.ane.0000144427.90174.b6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To monitor hypoperfusion of the peripheral tissues in critical illness caused by injury, we measured the concentrations of glucose, pyruvate, and lactate in traumatized and ischemic hamster flap tissue with the use of microdialysis. The interruption of the anatomic blood supply led to a drastic decrease in microvascular blood flow (laser Doppler flowmetry) and partial tissue oxygen tension (dye fluorescence quenching technique) in the ischemic part of the flap (both P < 0.01). In the traumatized area, blood flow, oxygen tension, and pyruvate were similar to the healthy control tissue throughout the experiments, whereas pyruvate was reduced in the ischemic tissue (P < 0.05 versus baseline and other tissues). Lactate was increased in both parts of the flap (P < 0.01 versus baseline and other groups for ischemic, not significant for traumatized). The sensitivity to detect ischemic hypoxia was 62% for lactate and 93% for lactate/pyruvate ratio (L/P) (P < 0.01). The specificity to discern ischemia-related from trauma-related changes was 71% for lactate and 70% for L/P (not significant). Our results suggest that L/P is more accurate than lactate for monitoring ischemia-related hypoxia after trauma. However, the rate of increased values originating from normally perfused but traumatized tissue was high for both markers.
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Affiliation(s)
- Claudio Contaldo
- *Department of Orthopedic, Plastic and Hand Surgery, Inselspital, University Hospital, CH-3010 Berne, Switzerland; †Institute of Anatomy, University of Berne, CH-3011 Berne, Switzerland
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Creteur J, De Backer D, Sun Q, Vincent JL. THE HEPATOSPLANCHNIC CONTRIBUTION TO HYPERLACTATEMIA IN ENDOTOXIC SHOCK: EFFECTS OF TISSUE ISCHEMIA. Shock 2004; 21:438-43. [PMID: 15087820 DOI: 10.1097/00024382-200405000-00007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We investigated the role of the hepatosplanchnic region in the hyperlactatemia observed during endotoxic shock. The study included 18 dogs anesthetized with pentobarbital and mechanically ventilated. After baseline measurements, including gut lactate production (GLP), liver lactate uptake (LLU), liver lactate extraction (LLE), and hepatosplanchnic lactate production (HSLP), each dog received 2 mg/kg of E. coli endotoxin. After a second set of measurements, cardiac tamponade was induced in 12 dogs (EDTX + Tamp) by repeated injections of normal saline into the pericardial sac to progressively reduce cardiac output and hepatic blood flow. The six remaining dogs served as septic controls (EDTX). From a net lactate consumer before endotoxin infusion, the gut became a lactate producer after the endotoxin infusion, with GLP increasing from -11.4 +/- 27.0 to 32.9 +/- 38.2 x 10(-3) mEq/min (P < 0.05). LLU increased from 48.1 +/- 26.2 to 86.6 +/- 45.2 x 10(-3) mEq/min (P < 0.05), so that LLE and HSLP did not change. In the EDTX + Tamp group, LLE became negative, and HSLP became positive only when hepatic oxygen delivery reached its critical value during cardiac tamponade. In the EDTX group, LLE remained positive and HSLP negative. In endotoxic shock, GLP is increased, but the liver can metabolize this additional load of lactate, so that the hepatosplanchnic area is not a major source of lactate unless the liver becomes profoundly hypoxic.
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Affiliation(s)
- Jacques Creteur
- Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium
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Mink SN, Jacobs H, Duke K, Bose D, Cheng ZQ, Light RB. N,N′,N′-triacetylglucosamine, an inhibitor of lysozyme, prevents myocardial depression in Escherichia coli sepsis in dogs*. Crit Care Med 2004; 32:184-93. [PMID: 14707578 DOI: 10.1097/01.ccm.0000104919.07538.04] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Reversible myocardial depression in sepsis has been ascribed to the release of inflammatory mediators. We recently found that lysozyme c (Lzm-S), consistent with that originating from the spleen, was a mediator of myocardial depression in an Escherichia coli model of septic shock in dogs. We further showed in a right ventricular trabecular (RVT) preparation that Lzm-S's depressant activity could be blocked by N,N',N" triacetylglucosamine (TAC), a competitive inhibitor of Lzm-S. We hypothesized that Lzm-S binds to or cleaves a cardiac membrane glycoprotein, thereby interfering with myocardial contraction in sepsis. In the present study, we examined whether TAC could prevent myocardial depression in an in vivo preparation and whether other related N-acetylglucosamine (NAG) structures could also inhibit Lzm-S's effect in RVT. DESIGN Randomized experimental study. SETTING University laboratory. SUBJECTS Anesthetized, mechanically ventilated dogs. INTERVENTIONS We produced sepsis by infusion of E. coli over an approximately 6-hr period. MEASUREMENTS AND MAIN RESULTS We examined the effect of TAC on stroke work, our primary index of myocardial function, when treatment was administered before sepsis (pretreatment) and after 1.5 hrs (early treatment study) and 3.5 hrs of sepsis (late treatment study; LTS). In the pretreatment study and early treatment study, myocardial depression would have not yet occurred but would have already been present in the late treatment study. In RVT, we assessed the effect of other NAG oligosaccharides and variants to the NAG structure on Lzm-S's depressant activity. In pretreatment and the early treatment study, TAC prevented the reduction in stroke work observed in nontreated septic groups but did not reverse the reduction found in the late treatment study. In RVT, of the compounds tested, only N,N'-diacetylglucosamine showed an inhibitory effect. CONCLUSIONS We found that TAC, a competitive inhibitor of Lzm-S, prevented myocardial depression in experimental sepsis. Only specific NAG structures are inhibitory to Lzm-S's depressant activity. TAC may be useful in attenuating cardiovascular collapse in sepsis.
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Affiliation(s)
- Steven N Mink
- Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg.
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Nemec A, Pecar J, Seliskar A, Kompan L, Butinar J. Assessment of acid-base status and plasma lactate concentrations in arterial, mixed venous, and portal blood from dogs during experimental hepatic blood inflow occlusion. Am J Vet Res 2003; 64:599-608. [PMID: 12755301 DOI: 10.2460/ajvr.2003.64.599] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effects of extended experimental hepatic blood flow occlusion (ie, portal triad clamping [PTC]) in dogs by measuring acid-base status and plasma lactate concentrations in arterial, mixed venous, and portal blood and evaluating the relationship between metabolic and concurrent hemodynamic changes. ANIMALS 6 healthy Beagles. PROCEDURE During anesthesia with isoflurane, cardiac output and arterial blood pressure were measured. Arterial, mixed venous, and portal blood samples were collected simultaneously for blood gas analyses and plasma lactate measurements before PTC and at 8-minute intervals thereafter. RESULTS PTC resulted in severe hemodynamic and metabolic alterations. Eight minutes after PTC, significant decreases in cardiac index from a baseline value of 3.40 +/- 0.27 to 1.54 +/- 0.26 L/min/m2 and in mean arterial blood pressure from a baseline value of 74 +/- 6 to 43 +/- 6 mm Hg were recorded. After PTC, results indicative of lactic acidosis were found in portal blood at 16 minutes, in mixed venous at 32 minutes, and in arterial blood at 48 minutes. Significant differences in measured variables were also found between arterial and portal blood samples, between mixed venous and portal blood samples, and between arterial and mixed venous blood samples after PTC, compared with differences at baseline. CONCLUSIONS AND CLINICAL RELEVANCE Analysis of mixed venous blood is preferable to analysis of arterial blood in the assessment of metabolic derangement. In a clinical setting, occluded portal blood is released to the systemic circulation, and the degree of reperfusion injury may depend on the metabolic status of pooled portal blood.
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Affiliation(s)
- Alenka Nemec
- Veterinary Faculty, University of Ljubljana, Gerbiceva 60, 1000 Ljubljana, Slovenia
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Severin PN, Uhing MR, Beno DWA, Kimura RE. Endotoxin-induced hyperlactatemia results from decreased lactate clearance in hemodynamically stable rats. Crit Care Med 2002; 30:2509-14. [PMID: 12441762 DOI: 10.1097/00003246-200211000-00017] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether endotoxin-induced hyperlactatemia in hemodynamically stable animals is due to increased lactate production or decreased lactate clearance by measuring lactate turnover rate in the vascular compartment (LTRvc). DESIGN Prospective, controlled trial. SETTING Research laboratory in a university hospital. SUBJECTS Male Sprague-Dawley rats weighing 275-425 g with chronic vascular catheters. INTERVENTIONS Chronically catheterized rats were treated with 6 microg/kg endotoxin or saline. LTRvc was determined from the specific activity of carbon-14 [14C]lactate in aortic blood during a constant infusion of [14C]lactate into the inferior vena cava. The role of the splanchnic organs in lipopolysaccharide-induced alterations in LTRvc was determined from the splanchnic first-pass clearance of [14C]lactate infused into the superior mesenteric artery and direct measurements of blood lactate concentration gradients across the splanchnic organs. MEASUREMENTS AND MAIN RESULTS Despite a 260% increase in lactate concentrations after lipopolysaccharide treatment, the specific activity of [14C]lactate and the LTRvc did not change, indicating that lipopolysaccharide-induced hyperlactatemia is caused by decreased lactate clearance from the vascular compartment rather than increased lactate flux into the vascular compartment. In contrast, lactate clearance by the splanchnic system was increased. The specific activity of [14C]lactate in aortic blood decreased 33% after lipopolysaccharide treatment when the [14C]lactate was infused into the superior mesenteric artery, indicating increased first-pass clearance of [14C]lactate by the splanchnic organs. Furthermore, the hepatic venous-aortic concentration gradient of lactate became increasingly negative after lipopolysaccharide treatment, indicating increased vascular extraction of lactate by the splanchnic system (0.07 +/- 0.07 micromol/mL vs. -0.34 +/- 0.14 micromol/mL). CONCLUSIONS Lipopolysaccharide-induced hyperlactatemia in hemodynamically stable rats is caused by a net decrease in lactate clearance from the vascular compartment despite the fact that the clearance of lactate by the splanchnic system remains intact.
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Affiliation(s)
- Paul N Severin
- Division of Critical Care, Department of Pediatrics, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL, USA
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Chrusch C, Bautista E, Jacobs HK, Light RB, Bose D, Duke K, Mink SN. Blood pH level modulates organ metabolism of lactate in septic shock in dogs. J Crit Care 2002; 17:188-202. [PMID: 12297996 DOI: 10.1053/jcrc.2002.35816] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Lactic acidosis is an important complication of septic shock. Alkali treatment such as sodium bicarbonate is often used to treat the low pH level that develops in sepsis. The effect of this treatment on lactate (Lac) clearance is not clear. In the present study, the objective was to examine whether blood pH level alters Lac metabolism in sepsis. Measurements were determined in a canine model of Escherichia coli sepsis after bolus infusion (5 mmol/kg) of either lactic acid (LA) or sodium lactate (NaL). In one preparation, Lac uptake by the splanchnic organs (SP), liver, lung, kidneys (Kid), and soft tissues of the lower extremity (SOL) was primarily determined, whereas in another preparation, Lac uptake by the head and neck region and lung was obtained. METHODS The dogs were studied while anesthetized and ventilated. After 4 hours of sepsis, either LA or NaL was given through a catheter positioned in the abdominal aorta in respective sepsis (SepLA, SepNaL) and nonsepsis groups (ConLA, ConNaL) (n approximately equal to 6 in each preparation). Catheters and flow probes were used to measure organ Lac uptake. Measurements were obtained at end infusion and at 15-minute intervals after infusion until 75 minutes after infusion. RESULTS Arterial clearance of Lac in the sepsis groups was slower as compared with the nonsepsis groups. In the liver, sepsis inhibited the uptake of LA as compared with the nonseptic group. In SP, both sepsis and pH affected Lac uptake in which an increase in uptake was found only after NaL infusion in the nonseptic group. In the head and neck region, Lac uptake was pH-level dependent and was found after LA infusion in the sepsis and nonsepsis groups. In the lung, Lac was produced after either LA or NaL infusion in all groups. Neither Kid nor SOL contributed to Lac uptake in any of the groups. CONCLUSION Lactate clearance was reduced in sepsis. Both effects of pH level and sepsis modulated the organ uptake of Lac in septic shock. Only a small amount of the total Lac infused could be accounted for by the organs measured in the present study. This suggests that additional organs may account for lactate removal in sepsis.
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Affiliation(s)
- Carla Chrusch
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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The Fibrinolytic Defect in Adult Respiratory Distress Syndrome: A New Therapeutic Opportunity? ACTA ACUST UNITED AC 2002. [DOI: 10.1097/00045413-200201000-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Affiliation(s)
- M J Tobin
- Division of Pulmonary and Critical Care Medicine, Loyola University of Chicago Stritch School of Medicine and Hines Veterans Affairs Hospital, Hines, Illinois 60141, USA.
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Affiliation(s)
- S Idell
- Department of Specialty Care Services, The University of Texas Health Center at Tyler, Tyler, Texas 75708, USA.
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Hilzenrat N, Arish A, Yaari A, Almog Y, Sikuler E. Blood viscosity, hemodynamics and vascular hindrance in a rat model of acute controlled bleeding and volume restitution with blood or Haemaccel. Acta Anaesthesiol Scand 2001; 45:371-6. [PMID: 11207476 DOI: 10.1034/j.1399-6576.2001.045003371.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hemorrhage and volume restitution with commercially available solutions is followed by reduced blood viscosity. Consequent hemodynamic changes may arise not only from the reduced viscosity itself but also from changes in vascular geometry induced by autoregulation processes. Vascular hindrance reflects the contribution of vascular geometry to flow. Our aim was to explore the possible effects of blood volume restitution with Haemaccel or blood, on regional blood flow and vascular geometry. METHODS Under ketamine anesthesia, blood was withdrawn at a rate of 0.3 ml/min for 15 min followed by 15 min of stabilization. The shed blood or Haemaccel was infused at the same rate and volume as used for withdrawal. Hemodynamic measurements were performed using radioactive microspheres. Blood viscosity was measured with an Ostwald viscometer. Vascular hindrance was calculated as the resistance/viscosity ratio. RESULTS Volume replacement with Haemaccel (n=10), compared to blood (n=10), was followed by increased cardiac output and portal venous inflow (37.1 +/- 9.0 and 3.1 +/- 0.5 vs 25.9 +/- 6.8 and 2.2 +/- 0.9 ml x min(-1) x 100 g bw(-1), respectively; P<0.05), decreased viscosity (2.8 +/- 1.3 vs 3.7 +/- 1.3, respectively; P<0.01) and decreased peripheral and splanchnic arteriolar resistance (3.8 +/- 1.1 and 40.9 +/- 7.6 vs 5.2 +/- 1.7 and 61.1 +/- 29.5 mmHg x ml(-1) x min x 100 g bw, respectively; P<0.05). No significant differences between the groups were observed in vascular hindrance and cardiac output distribution. CONCLUSION Volume replacement with Haemaccel, compared to blood, induced increase in systemic and splanchnic blood flows, reflecting mainly changes in viscosity and not in blood vessel geometry. These results suggest no significant difference in overall activation of autoregulation process between volume restitution with blood or Haemaccel.
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Affiliation(s)
- N Hilzenrat
- Gastroenterology Division, The Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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De Backer D, Creteur J, Silva E, Vincent JL. The hepatosplanchnic area is not a common source of lactate in patients with severe sepsis. Crit Care Med 2001; 29:256-61. [PMID: 11246302 DOI: 10.1097/00003246-200102000-00005] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the role of the splanchnic region in the hyperlactatemia of septic patients. DESIGN Prospective, observational study. SETTING Thirty-one-bed mixed medicosurgical intensive care unit. PATIENTS Ninety invasively monitored and mechanically ventilated patients with severe sepsis. MEASUREMENTS AND MAIN RESULTS Splanchnic lactate balance was measured in all patients. Splanchnic blood flow was determined by using the primed continuous indocyanine green infusion technique in 69 patients. In 71 patients, gastric mucosal Pco2 and the Pco2 gap (the difference between gastric and arterial Pco2) also were determined by using gas tonometry with an automated gas analyzer. In each patient, arterial, mixed-venous, and hepatic venous blood samples were obtained to determine hemoglobin oxygen saturations and lactate concentrations. Arterial and hepatic venous lactate concentrations were determined in triplicate and were averaged, and the arterial hepatic venous difference in lactate and lactate consumption were calculated. The splanchnic region produced lactate in only six of the 90 patients. Mean arterial pressure, cardiac index, arterial lactate, hepatic venous oxygen saturation, and catecholamine use were similar in the six patients with splanchnic lactate production and in the 84 others. The arterial hepatic venous differences in lactate and splanchnic lactate consumption were related directly to arterial lactate concentrations (y = 0.073x + 0.209, r(2) =.06, p <.05, and y = 0.06x + 0.183, r(2) =.08, p <.05, respectively) but were not related to Pco2 gap, to the gradient between mixed-venous and hepatic venous oxygen saturations, or to bilirubin concentrations. CONCLUSIONS Splanchnic lactate release is uncommon in septic patients, even when hyperlactatemia is severe.
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Affiliation(s)
- D De Backer
- Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium
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Idell S, Mazar AP, Bitterman P, Mohla S, Harabin AL. Fibrin turnover in lung inflammation and neoplasia. Am J Respir Crit Care Med 2001; 163:578-84. [PMID: 11179137 DOI: 10.1164/ajrccm.163.2.2005135] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- S Idell
- Department of Medical Specialties, University of Texas Health Center at Tyler, Tyler, Texas, USA
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