This study introduced about lactate, metabolism process, values of blood lactate in clinical diagnosis.
Lactic Acid ; blood ; diagnosis

BACKGROUND: Recent blood gas analyzers offer electrolytes, Hb-derivatives (O2 Hb, HHb, COHb, MetHb and SulfHb), content of total hemoglobin (ctHb), and metabolites (glucose and lactate) as well as conventional blood gas parameters. Evaluation and efficient control of these instruments affect greatly monitoring and therapy of patients. The authors evaluated a recently introduced blood gas analyzer, the Roche OMNI 9 (Roche Diagnostics) for precision, analytic speed, function, features and comparability with other instruments according to NCCLS guidelines to see if it was suitable for the stat analyzer. METHODS: Commercial control materials, AUTO-trol PLUS Level 1, 2, 3 (Roche Diagnostics) were analyzed to evaluate the within-day precision, the between-day precision, and patient samples were used to evaluate comparability with other instruments. RESULTS: The within-day and the between-day precisions of the Roche OMNI 9 showed a very low CV of 0- 3.93% and 0- 3.99%, respectively, in all parameters except the lactate, which had moderate CV values of 7.74% and 5.93% in Level 3 QC material (low concentration). In compari-son with the Bayer instrument, correlation was high in all parameters with the r(2) value ranging from 0.9441 to 0.9901 except for COHb (r(2)=0.4239) and MetHb (r(2)=0.0034) whose concentrations were in the lower level. Glucose (r(2)=0.991), lactate (r(2)=0.9824), and hemoglobin (r(2)=0.9961) showed a rather high correlation. The Roche OMNI 9 could analyze 40 samples of blood gas and 27 samples of full parameter per hour, which was comparable to the Bayer M855. CONCLUSIONS: The Roche OMNI 9 showed high precision and rapid turnaround time for blood gas and in a selection of glucose, lactate and hemoglobin.
Blood Gas Analysis ; Electrolytes ; Glucose ; Humans ; Lactic Acid

BACKGROUND: Because of a lack of substances for platelet (PLT) metabolism and preservation, normal saline (NS) washed PLTs can only be stored for short lengths of time. However, the use of platelet additive solutions (PAS) could help solve this problem. In this study, the in vitro quality of NS washed platelets (wPLTs) stored in two types of PAS were compared with those of wPLTs stored in NS. METHODS: Five units of NS washed apheresis platelets were pooled aseptically and separated into five aliquots for storage in NS only as well as T-PAS+ (Terumo BCT, Lakewood, CO, USA) and CompoSol PS (Fenwal, Lake Zurich, IL, USA) with or without 15 mM glucose. The parameters of wPLTs quality were assessed up to 48 hrs after washing and the whole experiment was repeated 10 times independently. RESULTS: wPLTs in two kinds of PAS had better quality than wPLTs in NS, and wPLTs in T-PAS+ showed better quality than those in CompoSol PS. PAS-stored wPLTs with added glucose maintained stable CD62P and Annexin V expression during storage, but exhibited increased lactate accumulation. Evaluation of in vitro quality revealed that all wPLTs had a rating of 4 immediately after washing. However, only T-PAS+-stored wPLTs with glucose maintained a rating of 4 up to 48 hrs of post-washing. CONCLUSION: Using PAS storage for wPLTs may be beneficial compared to NS. The results presented herein suggest that T-PAS+ containing glucose has the potential to extend storage time by up to 48-hours.
Annexin A5 ; Blood Component Removal ; Blood Platelets* ; Blood Preservation ; Glucose ; In Vitro Techniques ; Lactic Acid ; Lakes ; Metabolism

The key to the treatment of septic shock is to provide adequate oxygen supply and improve tissue perfusion. Lactate and central venous oxygen saturation (ScvO) are commonly used as the indices of oxygen metabolism, but tissue hypoxia may still exist even when lactate and ScvOare within the normal range. Arteriovenous difference in carbon dioxide partial pressure (COgap) can accurately reflect oxygen delivery when ScvOis in the normal range. This article reviews the advantages and shortages of lactate, lactate clearance rate, ScvO, and COgap in evaluating tissue hypoxia, in order to provide a reference for treatment and severity evaluation of septic shock.
Carbon Dioxide ; blood ; Humans ; Lactic Acid ; metabolism ; Metabolic Clearance Rate ; Oxygen ; blood ; Shock, Septic ; metabolism

PURPOSEExsanguination is the most common leading cause of death in trauma patients. The massive transfusion (MT) protocol may influence therapeutic strategies and help provide blood components in timely manner. The assessment of blood consumption (ABC) score is a popular MT protocol but has low predictability. The lactate level is a good parameter to reflect poor tissue perfusion or shock states that can guide the management. This study aimed to modify the ABC scoring system by adding the lactate level for better prediction of MT.

METHODSThe data were retrospectively collected from 165 trauma patients following the trauma activated criteria at Songklanagarind Hospital from January 2014 to December 2014. The ABC scoring system was applied in all patients. The patients who had an ABC score ≥2 as the cut point for MT were defined as the ABC group. All patients who had a score ≥2 with a lactate level >4 mmol/dL were defined as the ABC plus lactate level (ABC + L) group. The prediction for the requirement of massive blood transfusion was compared between the ABC and ABC + L groups. The ability of ABC and ABC + L groups to predict MT was estimated by the area under the receiver operating characteristic curve (AUROC).

RESULTSAmong 165 patients, 15 patients (9%) required massive blood transfusion. There were no significant differences in age, gender, mechanism of injury or initial vital signs between the MT group and the non-MT group. The group that required MT had a higher Injury Severity Score and mortality. The sensitivity and specificity of the ABC scoring system in our institution were low (81%, 34%, AUC 0.573). The sensitivity and specificity were significantly better in the ABC + L group (92%, 42%, AUC = 0.745).

CONCLUSIONThe ABC scoring system plus lactate increased the sensitivity and specificity compared with the ABC scoring system alone.

Adult ; Blood Transfusion ; Female ; Humans ; Lactic Acid ; blood ; Male ; Predictive Value of Tests ; Trauma Severity Indices

Rapid administration of solution containing dextrose results in marked hyperglycemia and osmotic diuresis. Jeon reported blood sugar of 200 to 465mg per 100ml. in patients receiving 10ml per hour of 5% dextrose in 1/3 saline and the urine output went up to 340ml per hour. This study was undertatken to evaluate Elitol asto changes of blood sugar concentrations when it was administered rapidly. Elitol is a maltose contained in a balanced salt solution shich has a different effect in the blood sugar level from a gulcose contained solution. 40 patients were chosen at random and divided into 3 groups i.e. one group 5% dextrose in water(D5/W), the second group 5% dextrose in lactated ringer's solution(D5/LR) and the third group the Elitol solution. Patient's blood was drawn on the operating table prior to starting I.V. infusion for the measurement of blood sugar in various conditions of N.P.O. Intravenous fluid was administered at 10ml/kg/hour while anesthesia was induced and maintained with an endotracheal tube in place. The blood samples were taken after one hour, 2 hours and 3 hours from the time the LV. infusion started. In the group of 5% dextrose in water, the value of blood sugar was 82+/-mg% at NPO2 205+/-36mg% at 1 hour, 273+/-49mg% at 2 hours, and 316+/-63mg% at 3 hours. The blood sugar values increased markedly. In the group of 5% dextrose in lactate Ringer's solution the values of blood sugar were 99+/-16mg% at NPO, 255+/-49mg% at 1 hour, 285+/-54mg% at 2 hours and 292+/-78mg% at 3hours. The values of blood sugar increased significantly and were very similar to the 1st group. In the group of Elitol, the values of blood sugar were 92+/-12mg% at NPO, 126+/-21mg% at 1 hour, 131+/-24mg% at 2 hours and 128+/-23mg% at 3hours. The increase of blood sugar levels were insignificant which is entirely different from the change of blood sugar in the above groups. Accordingly we came to the conclusion that rapid infusion of Elitol solution affects the blood sugar levels insignificantly compared to the dextrose containing solutions which increase the blood sugar levels greatly.
Anesthesia ; Blood Glucose* ; Diuresis ; Glucose ; Humans ; Hyperglycemia ; Lactic Acid ; Maltose ; Operating Tables ; Water

BACKGROUND: The use of point of care glucometer is widely established. However, the reliability of glucometer can vary according to the type of patients tested. Chemical interference with some current glucometer has been observed in patients undergoing peritoneal dialysis. StatStrip(R) (Nova Biomedical, USA) has been designed to compensate for this interference effect. So we compared the analytic performance and interference response of StatStrip(R) to two conventional glucometers. And we also evaluated the interference response with samples in patients undergoing peritoneal dialysis. METHODS: StatStrip(R) and two other glucometers were compared for linearity, imprecision, correlations with Advia 2400(TM) (Bayer Diagnostics, USA). Interference by lactate, maltose, were evaluated. Interferences in 20 samples of patients undergoing peritoneal dialysis were also evaluated. RESULTS: The coefficients of variation (CVs) of within-run precision were 1.70-3.77% and CVs of total precision were 1.98-3.99%. The linearity was R2=0.9776-0.988 (P<0.001). High correlation was found in each glucometer and the Advia 2400(TM). But all the glucometers showed a variable positive or negative bias compared with reference method. Including samples of patients undergoing peritoneal dialysis, maltose did not significantly influence the glucose concentration in StatStrip(R) and one of the conventional glucometers within 20% difference range. Lactate and hematocrit did not significantly influence the glucose concentration in all glucometers. CONCLUSIONS: StatStrip(R) shows good linearity, precision, correlation with the reference method and shows minimal interference effects. Our results indicate that StatStrip(R) also has clinical reliability when used in a peritoneal dialysis setting.
Bias (Epidemiology) ; Blood Glucose ; Glucose ; Hematocrit ; Humans ; Lactic Acid ; Maltose ; Peritoneal Dialysis

Prompt, precise differentiation between various forms of meningitis-aseptic, bacterial and tuberculous-is critical difficult problem for the practicing pediatrician. The present invesigation was carried out to assess the diagnostic usefullness of lactic acid levels in CSF. Fresh samples of CSF and blood were collected from 75 infant and children with meningitis and 25 normal children. CSF lactic acid. CSF sugar, blood lactic acid and blood sugar were estimated from them. These subjects were divided into 4 groups : Group 1 (normal-25 cases), Group 2 (aseptic meningitis-25 cases), Group 3 (purulent meningitis-20 cases), Group 4 (T.B. meningitis-30 cases). The results were as follows : 1. In normal gruop, CSF lactic acid was 5.8mg/dl and blood lactic acid was 7.1mg/dl, The ratio of CSF Lactic acid to blood lactic acid was approximately 0.8. 2. In Group 2. (aseptic meningitis), CSF lactic acid was 8.8mg/dl and blood lactic acid was 7.4mg/dl. The CSF value was slightly increased compare to normal CSF lactic acid levels. CSF suger and lactic acid were not correlated. 3. In the purulent meningitis group, CSF lactic acid was markedly increased to a significant level compare to the normal value. The mean was 36.4mg/dl. Blood lactic acid was 26.2mg/dl. 4. In T.B. meningitis, There as a mederate increase of lactic acid significantly ifferent from normal values. The mean was 25.8mg/dl. Blood lactic acid also increased. The mean was 18.9mg/dl. A positive linear correlation between CSF lactic acid and blood lactic was noted. 5. On the 3rd hospital day, CSF lactic acid level wsa approximately half level of the initial values inpurulent meningitis. It returned to normal level on 6th hospital day. In T.B. meningitis, CSF lactic acid also showeda decrease from the 5th hospital day. And returned to normal values on 20th hospital day. Concerning the above results, CSF lactic acid could be a possiblely be a good index in differential diagnosis of meningitis and in evaluation of it's clinical course.
Blood Glucose ; Cerebrospinal Fluid* ; Child* ; Diagnosis, Differential ; Humans ; Infant* ; Lactic Acid* ; Meningitis* ; Reference Values

BACKGROUNDMany studies have shown that continuous renal replacement therapy (CRRT) could clean lactate and treat the hyper-lactatemia. On the contrary, some other studies found that filter lactate clearance only accounted for a very small part of total lactate clearance and the hemofilter's contribution to the overall lactate clearance was negligible. The objective of this study was to evaluate the effects of various doses of continuous veno-venous hemofiltration (CVVH) on plasma lactate elimination in critically ill patients.

METHODSPatients were divided into three groups according to their incipient plasma lactate concentration. Group A: lactate ≤ 2 mmol/L, group B: lactate 2-5 mmol/L, group C: lactate ≥ 5 mmol/L. Three different doses (20 ml × kg(-1)× h(-1), 35 ml × kg(-1)× h(-1) and 45 ml × kg(-1)× h(-1)) of CVVH were applied to critically ill patients who experiencing CVVH. The concentrations of plasma lactate in pre-(A), post-dialyzer (V) sites and ultrafiltrate were measured after each dosage of CVVH was carried out for 30 minutes. Rate of lactate clearance by the filter (RLC) and filter lactate clearance (FLC) and Lactate-Sieving Coefficient (LSC) were calculated under different circumstances, including different doses of CVVH and different incipient lactate levels.

RESULTSFifteen patients were enrolled and 104 blood samples were drawn and lactate concentrations were measured in this study. RLC was found increased ((9.36 ± 9.73) mmol/h, (13.92 ± 12.56) mmol/h and (16.52 ± 12.71) mmol/h, P < 0.05 respectively) with the dose of CVVH increased. RLC was also increased ((3.46 ± 1.46), (10.38 ± 5.50) and (24.53 ± 14.69) mmol/h, P < 0.05 respectively) with the incipient lactate increased. FLC was increased ((1.95 ± 0.63), (2.95 ± 0.74) and (3.45 ± 0.54) L/h, P < 0.05 respectively) with the dose of CVVH increased. There was no significant difference of LSC in different doses of CVVH and different incipient lactate levels.

CONCLUSIONSPlasma lactate can be eliminated by CVVH and different doses of CVVH affect the rate of lactate clearance in critically ill patients.

Adult ; Aged ; Aged, 80 and over ; Critical Illness ; Female ; Hemofiltration ; Humans ; Lactic Acid ; blood ; Male ; Middle Aged

This study investigated the influence of different durations of aerobic exercise on fuel utilization, lactate levels and antioxidative status in trained rats. Forty rats underwent physical training (T, n = 20) or non- training (NT, n = 20) for 6 weeks. For physical training, animals exercised on a treadmill for 30 min 5 days per week. At the end of week 6, the animals in each group were subdivided into BE, DE-0.5, DE-1 and DE-2, which were sacrificed at the end of week 6 without having performed exercise or after exercise on a treadmill for 0.5h, 1h and 2h, respectively, immediately before being sacrificed. The plasma glucose level in DE-2 of the NT group was significantly lower than in the other groups. Muscle and liver glycogen levels were significantly lower in DE-1 and DE-2, but there were no significant differences between DE-1 and DE-2 in the T group. Liver protein in DE-2 of the NT group was significantly lower. Muscle TG levels were decreased in DE-0.5 of the T group, while those of the NT group were decreased in DE-1. FFA levels were increased in DE-0.5 of the T group and in DE-1 of the NT group. Lactate levels were increased in DE-0.5 of the NT group, while they were increased in DE-1 of the T group. Catalase activity of the T group was lower in BE but higher in DE-0.5, DE-1 and DE-2. SOD activities were higher in trained rats, while the GSH/GSSG ratios were higher in BE, DE-0.5 and DE-1 in the T group, and there was no difference in that of DE-2. There were no differences in MDA levels in BE and DE-0.5, but they were significantly lower in DE-1 and DE-2 of the T group. Overall, the results of this study, suggest that training may improve exercise performance by facilitating the mobilization and oxidation of fat and conserving limited carbohydrate storage, and that it may delay the onset of fatigue and enhance the antioxidative defense system, but cannot support two hours of vigorous exercise.
Animals ; Blood Glucose ; Catalase ; Exercise* ; Fatigue ; Lactic Acid* ; Liver ; Liver Glycogen ; Muscles ; Rats*