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Intensive Care Medicine
Published in: Intensive Care Medicine 11/2003

01-11-2003 | Brief Report

Gastric PgCO2 and Pg-aCO2 gap are related to d-lactate and not to l-lactate levels in patients with septic shock

Authors: Martijn Poeze, Barbara C. J. Solberg, Jan Willem M. Greve, Graham Ramsay

Published in: Intensive Care Medicine | Issue 11/2003

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Abstract

Objective

Intestinal ischemia causes an increase in lactate production and gastric intramucosal carbon dioxide partial pressure (PgCO2). However, no linear relationship between systemic l-lactate levels and gastric tonometry during intestinal ischemia has been found, probably since l-lactate is rapidly cleared from the circulation by the liver. In contrast, the rate of d-lactate clearance from the circulation by the liver is considerably lower than that of l-lactate, and d-lactate may therefore be more closely related to measurements of gastric tonometry than l-lactate values.

Design and setting

Prospective, observational study in a university-affiliated mixed intensive care unit.

Subjects

Twenty critically ill patients with septic shock.

Measurements and results

During the first 24 h of admission to the intensive care unit at least two blood samples were taken for d- and l-lactate measurements and arterial blood gases, Simultaneously, gastric PgCO2 was measured using capnographic tonometry. The intramucosal-arterial PCO2 gap was calculated using gastric intramucosal PgCO2 and arterial PCO2 from arterial blood. d-Lactate was significantly correlated to PgCO2 values and to the mucosal-arterial PCO2 gap. There was no relationship between l-lactate and PgCO2 or the mucosal-arterial PCO2 gap. d-lactate and l-lactate values were significantly correlated.

Conclusions

During sepsis intestinal production of d-lactate is related to gastric intramucosal PCO2. No such relationship was found between l-lactate values and PgCO2
Literature
1.
Oh MS, Phelps KR, Traube M, Barbosa-Saldivar JL, Boxhill C, Carroll HJ (1979) D-lactic acidosis in a man with the short-bowel syndrome. N Engl J Med 301:249–252PubMed
2.
Hove H, Mortensen PB (1995) Colonic lactate metabolism and D-lactic acidosis. Dig Dis Sci 40:320–330PubMed
3.
Murray MJ, Barbose JJ, Cobb CF (1993) Serum D (−)-lactate levels as a predictor of acute intestinal ischemia in a rat model. J Surg Res 54:507–509CrossRefPubMed
4.
Murray MJ, Gonze MD, Nowak LR, Cobb CF (1994) Serum D (−)-lactate levels as an aid to diagnosing acute intestinal ischemia. Am J Surg 167:575–578PubMed
5.
Sun XQ, Fu XB, Zhang R, Lu Y, Deng Q, Jiang XG, Sheng ZY (2001) Relationship between plasma D (−)-lactate and intestinal damage after severe injuries in rats. World J Gastroenterol 7:555–558PubMed
6.
Brooks GA (1986) Lactate production under fully aerobic conditions: the lactate shuttle during rest and exercise. Fed Proc 45:2924–2929PubMed
7.
Takala J, Uusaro A, Parviainen I, Ruokonen E (1996) Lactate metabolism and regional lactate exchange after cardiac surgery. New Horiz 4:483–491PubMed
8.
Elizalde JI, Hernandez C, Llach J, Monton C, Bordas JM, Pique JM, Torres A (1998) Gastric intramucosal acidosis in mechanically ventilated patients: role of mucosal blood flow. Crit Care Med 26:827–832PubMed
9.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RA, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 101:1644–1655PubMed
10.
Brandt RB, Siegel SA, Waters MG, Bloch MH (1980) Spectrophotometric assay for D-(–)-lactate in plasma. Anal Biochem 102:39–46PubMed
11.
Trinder TJ, Lavery GG, Fee JP, Lowry KG (1995) Low gastric intramucosal pH: incidence and significance in intensive care patients. Anaesth Intensive Care 23:315–321PubMed
12.
Poeze M, Takala J, Greve JWM, Ramsay G (2000) Pre-operative tonometry is predictive for mortality and morbidity in high-risk surgical patients. Intensive Care Med 26:1272–1281CrossRef
13.
Gomersall CD, Joynt GM, Ho KM, Young RJ, Buckley TA, Oh TE (1997) Gastric tonometry and prediction of outcome in the critically ill. Arterial to intramucosal pH gradient and carbon dioxide gradient. Anaesthesia 52:619–623PubMed
14.
Smith SM, Eng HK, Buccini F (1986) Use of D-lactic acid measurement in the diagnosis of bacterial infections. J Infect Dis 154:658–664PubMed
15.
Heino A, Hartikainen J, Merasto ME, Alhava E, Takala J (1998) Systemic and regional pCO2 gradients as markers of intestinal ischaemia. Intensive Care Med 24:599–604CrossRefPubMed
16.
Tallgren M, Makisalo H, Hockerstedt K, Lindgren L (1999) Hepatic and splanchnic oxygenation during liver transplantation. Crit Care Med 27:2383–2388PubMed
17.
Uribarri J, Oh MS, Carroll HJ (1998) D-lactic acidosis. A review of clinical presentation, biochemical features, and pathophysiological mechanisms. Medicine (Baltimore) 77:73–82
18.
Poeze M, Froon AHM, Greve JWM, Ramsay G (1998) D-lactate as an early marker of intestinal ischaemia after ruptured abdominal aneurysm repair. Br J Surg 85:1221–1224PubMed
19.
Tugtekin IF, Radermacher P, Theisen M, Matejovic M, Stehr A, Ploner F, Matura K, Ince C, Georgieff M, Traeger K (2001) Increased ileal-mucosal-arterial PCO2 gap is associated with impaired villus microcirculation in endotoxic pigs. Intensive Care Med 27:757–766PubMed
Metadata
Title
Gastric PgCO2 and Pg-aCO2 gap are related to d-lactate and not to l-lactate levels in patients with septic shock
Authors
Martijn Poeze
Barbara C. J. Solberg
Jan Willem M. Greve
Graham Ramsay
Publication date
01-11-2003
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 11/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-003-1944-3

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