The Study of Plasma D-lactate Level and Acid-base Imbalance in Cirrhotic Patients.
- Author:
Sang Woong HAN
1
;
Jun Ho RYU
;
Dong Kyu LEE
;
Ile Kyu PARK
;
Joo Hyun SOHN
;
Choon Suk KEE
;
Ho Jung KIM
Author Information
1. Department of Internal Medicine, College Medicine, Hanyang University, Seoul, Korea. kimhj@hanyang.ac.kr
- Publication Type:Original Article
- Keywords:
Cirrhosis of the liver;
D-lactate;
L- lactate;
Acid-base disorder
- MeSH:
Acid-Base Imbalance*;
Acidosis;
Alkalosis, Respiratory;
Anti-Bacterial Agents;
Hepatic Insufficiency;
Human Body;
Humans;
Lactic Acid;
Lactulose;
Liver;
Liver Cirrhosis;
Metabolism;
Plasma*
- From:Korean Journal of Nephrology
2002;21(1):47-54
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: D-lactate, optical isomer of L-lactate is not a human metabolite. Once the D-lactate enters the human body, it is mainly metabolized in liver. The metabolism of D-lactate can be changed in patients with decompensated liver cirrhosis with the exposure of antibiotics and the frequent trial of lactulose, if neccessory. The aim of this study is to analyze blood D-lactate level in cirrhotic patients and it's relationship with the degree of hepatic insufficiency and acid-base imbalance. METHODS: Plasma L-lactate and D-lactate levels were measured in 40 cirrhotic patients classified by Child-Pugh system with L-LDH and D-LDH with comparison of their changes before and after the use of antibiotics and lactulose(n=14). Also, acid-base disorders were analyzed in 35 cirrhotic patients, and plasma L, D-lactate levels were determined in each acid-base disorder. RESULTS: Plasma D-lactate level was not significantly elevated in cirrhotic patients compared to the control group(2.34+/-.48 mmol/L vs. 1.63+/-.26 mmol/ L, p=NS), but some patients(n=4, 10%) revealed abnormally elevated D-lactate level. The plasma L, D- lactate levels were not different in subgroups classified by Child-Pugh system as well as by underlying causes of liver cirrhosis, and plasma D-lactate level was not sugnificnatly different before and after the exposure of antibiotics and lactulose. Plasma D-lactate level was significantly increased in 3 patients with respiratory alkalosis and metabolic acidosis(12+/-.98 mmol/L) compared to others(p<0.05). CONCLUSION: These results suggest that, regardless of its decompensated degree and exposure to drugs, a subset of patients with liver cirrhosis can develop elevation of D-lactate in blood, particularly when metabolic acidosis is accompanied.
