Reply to: High lactate is common, not alone a reason to stop resuscitation in IHCA

To study the role of muscle mass and muscle activity on lactate and energy kinetics during exercise, whole body and limb lactate, glucose, and fatty acid fluxes were determined in six elite cross-country skiers during roller-skiing for 40 min with the diagonal stride (Continuous Arm + Leg) followed by 10 min of double poling and diagonal stride at 72–76% maximal O2 uptake. A high lactate appearance rate (Ra, 184 ± 17 μmol · kg−1 · min−1) but a low arterial lactate concentration (∼2.5 mmol/l) were observed during Continuous Arm + Leg despite a substantial net lactate release by the arm of ∼2.1 mmol/min, which was balanced by a similar net lactate uptake by the leg. Whole body and limb lactate oxidation during Continuous Arm + Leg was ∼45% at rest and ∼95% of disappearance rate and limb lactate uptake, respectively. Limb lactate kinetics changed multiple times when exercise mode was changed. Whole body glucose and glycerol turnover was unchanged during the different skiing modes; however, limb net glucose uptake changed severalfold. In conclusion, the arterial lactate concentration can be maintained at a relatively low level despite high lactate Ra during exercise with a large muscle mass because of the large capacity of active skeletal muscle to take up lactate, which is tightly correlated with lactate delivery. The limb lactate uptake during exercise is oxidized at rates far above resting oxygen consumption, implying that lactate uptake and subsequent oxidation are also dependent on an elevated metabolic rate. The relative contribution of whole body and limb lactate oxidation is between 20 and 30% of total carbohydrate oxidation at rest and during exercise under the various conditions. Skeletal muscle can change its limb net glucose uptake severalfold within minutes, causing a redistribution of the available glucose because whole body glucose turnover was unchanged.

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Biochemical Analysis of Neoplastic Versus Nonneoplastic Abdominal Effusions in Dogs

Journal of the American Animal Hospital Association ◽

10.5326/0400372 ◽

2004 ◽

Vol 40 (5) ◽

pp. 372-375 ◽

Cited By ~ 15

Author(s):

Derek D. Nestor ◽

Sheila M. McCullough ◽

David J. Schaeffer

Keyword(s):

Prospective Study ◽

Biochemical Parameters ◽

Biochemical Analysis ◽

Lower Glucose ◽

Low Glucose ◽

Malignant Effusions ◽

Lactate Levels ◽

High Lactate

This prospective study of 15 dogs evaluated biochemical parameters in abdominal effusions of neoplastic and nonneoplastic origin in an attempt to identify markers for malignant effusions. Dogs in the neoplastic group had statistically significant lower glucose concentrations (mean, 72.6 mg/dL versus 110.0 mg/dL; P=0.0431) and higher lactate levels (mean, 3.81 mmol/L versus 1.68 mmol/L; P=0.0377) in their abdominal fluid than did dogs in the nonneoplastic group, indicating that low glucose and high lactate in abdominal effusions may be markers for neoplasia.

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Effects of sudden melon intake on ruminal parameters of non-adapted sheep

Pesquisa Veterinária Brasileira ◽

10.1590/s0100-736x2016000500004 ◽

2016 ◽

Vol 36 (5) ◽

pp. 378-382 ◽

Cited By ~ 3

Author(s):

Francisco L.C. Oliveira ◽

Raimundo A. Barrêto Júnior ◽

Antonio H.H. Minervino ◽

Marcondes Dias Tavares ◽

Rodolfo Gurgel Vale ◽

...

Keyword(s):

Volatile Fatty Acid ◽

Dry Matter ◽

Sugar Content ◽

The Other ◽

Ruminal Fluid ◽

Ruminal Acidosis ◽

Rumen Ph ◽

Lactic Acid Content ◽

High Sugar Content ◽

High Lactate

Abstract: This study evaluated the effects of varying amounts of melon with high sugar content offered to sheep without prior melon experience and that were not adapted to consuming it. We used 12 eight-month-old, rumen-cannulated crossbred sheep weighing 25 kg each. The animals received a base diet of roughage, and then half were randomly selected to have 25% of their diet replaced with melon (G25%) and the other half had 75% of their diet replaced with melon (75%). Ruminal fluid was collected before administration of melon and at 0, 3, 6, 12, 18, and 24 h after the administration of the fruit. Sheep from the G25% group presented volatile fatty acid ruminal acidosis (sub-acute) between 3 and 6 h after consumption. This acidosis was characterized by a rumen pH slightly lower than 5.6, increased discrete L-lactic acid content, and increased redox potential (RP) and methylene blue redox (MBR) time of the ruminal fluid. The G75% group presented lactic ruminal acidosis at T6h, characterized by a rumen pH lower than 5.0, high lactate-L content, increased RP and MBR time, and increased ruminal fluid osmolarity. Therefore, offering large amounts of melon (75% of dry matter (DM)) is not recommended but 25% of DM of this fruit can be used safely.

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Persistent high lactate level as a sensitive MR spectroscopy indicator of completed infarction

Journal of Neurosurgery ◽

10.3171/jns.1990.72.5.0763 ◽

1990 ◽

Vol 72 (5) ◽

pp. 763-766 ◽

Cited By ~ 26

Author(s):

Kiyohiro Houkin ◽

Ingrid L. Kwee ◽

Tsutomu Nakada

Keyword(s):

Magnetic Resonance ◽

Cerebral Infarction ◽

Mr Spectroscopy ◽

The Other ◽

Proton Spectroscopy ◽

Normal Pattern ◽

Content Type ◽

Lactate Levels ◽

High Lactate ◽

Fine Print

✓ Serial proton (1H) and phosphorus-31 (31P) magnetic resonance (MR) spectroscopy of cerebral infarction was performed in rats to assess the sensitivity of these techniques for use in clinical cerebral infarction. In this experimental chronic infarction model, 31P spectroscopy tended to return to a “normal” pattern within 24 hours after induction of infarction in spite of pathologically proven completed infarction and, therefore, appeared not to be sensitive enough for clinical application. On the other hand, proton spectroscopy invariably showed persistent high lactate levels and was capable of distinguishing completed infarction from reperfused recovered brain. Persistent high lactate levels appear to be a good MR spectroscopic indicator of completed infarction.

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Clinical Features and Risk Factors Associated with Mortality in Critically ill Children Requiring Continuous Renal Replacement Therapy

10.21203/rs.3.rs-40243/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Muhterem Duyu ◽

Ceren Turkozkan

Keyword(s):

Risk Factors ◽

Respiratory Failure ◽

Renal Replacement Therapy ◽

Renal Disease ◽

Continuous Renal Replacement Therapy ◽

Critically Ill ◽

Odds Ratio ◽

Critically Ill Children ◽

Factors Associated ◽

High Lactate

Abstract Background: The aims of this study were to describe the epidemiology and demographic characteristics of critically ill children requiring continuous renal replacement therapy (CRRT) at our pediatric intensive care unit (PICU) and to explore risk factors associated with mortality. Methods: A retrospective cohort of 121 critically ill children who received CRRT from May 2015 to May 2020 in the PICU of a tertiary healthcare institution was evalauted. The demographic information, admission diagnosis, indication for CRRT, clinical variables at the initiation of CRRT, time related variables and the laboratory results at initiation of CRRT were compared between survivors and non-survivors.Results: The most common diagnoses were renal disease (30.6%), hemato-oncological disease (12.4%), and sepsis (11.6%). The overall mortality was 29.8%. When compared according to diagnosis at admission, we found that patients with hemato-oncologic disease (73.3%) and those with pneumonia/respiratory failure (72.7%) had the highest mortality, while patients with renal disease had the lowest mortality (5.4%). The most common CRRT indications were: electrolyte or acid base imbalance (38.8%), acute kidney injury (29.8%) and fluid overload (14.9%). There was no relationship between mortality and indication for CRRT. The time interval between PICU admission and CRRT initiation was also unassociated with mortality (p=0.146). In patients diagnosed with sepsis, time until the initiation of CRRT was significantly shorter in survivors compared to non-survivors (p=0.004). Based on multivariate logistic regression, presence of comorbidity (odds ratio: 5.71; %95 CI: 1.16-27.97), being diagnosed with pneumonia/respiratory failure at admission (odds ratio: 16.16; %95 CI: 1.56-167.01), and high lactate level at the initiation of CRRT (odds ratio: 1.43; %95 CI: 1.17-1.79) were independently associated with mortality.Conclusions: In the context of the population studied mortality rate was lower than previously reported. In critically ill children requiring CRRT, mortality seems to be related to underlying disease, presence of comorbidity, and high lactate levels at CRRT initiation. We also found that early initiation of CRRT in sepsis can reduce mortality.

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Erroneously High Lactate: A Guide to Diagnosing Ethylene Glycol Poisoning

Biomedicine Hub ◽

10.1159/000499967 ◽

2019 ◽

Vol 4 (2) ◽

pp. 1-3

Author(s):

Mayanka Kamboj ◽

Harini Bejjanki ◽

Saraswathi Gopal ◽

Rupam Ruchi

Keyword(s):

Lactic Acid ◽

Lactic Acidosis ◽

Ethylene Glycol ◽

Critically Ill Patients ◽

Poor Prognosis ◽

Acid Level ◽

Lactic Acid Level ◽

Analytical Interference ◽

Ethylene Glycol Poisoning ◽

High Lactate

A high lactic acid level in critically ill patients is a marker of poor prognosis. However, lactic acidosis in ethylene glycol (EG) poisoning should be interpreted cautiously as analytical interference is observed with EG metabolites.

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Improved energy homeostasis of the heart in the metabolic state of exercise

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.2000.279.4.h1490 ◽

2000 ◽

Vol 279 (4) ◽

pp. H1490-H1501 ◽

Cited By ~ 73

Author(s):

Gary W. Goodwin ◽

Heinrich Taegtmeyer ◽

Keyword(s):

Fatty Acids ◽

Fatty Acid ◽

Fatty Acid Oxidation ◽

Energy Homeostasis ◽

Acid Oxidation ◽

High Fat ◽

Nonesterified Fatty Acids ◽

Malonyl Coa ◽

Metabolic Conditions ◽

High Lactate

We postulate that metabolic conditions that develop systemically during exercise (high blood lactate and high nonesterified fatty acids) are favorable for energy homeostasis of the heart during contractile stimulation. We used working rat hearts perfused at physiological workload and levels of the major energy substrates and compared the metabolic and contractile responses to an acute low-to-high work transition under resting versus exercising systemic metabolic conditions (low vs. high lactate and nonesterified fatty acids in the perfusate). Glycogen preservation, resulting from better maintenance of high-energy phosphates, was a consequence of improved energy homeostasis with high fat and lactate. We explained the result by tighter coupling between workload and total β-oxidation. Total fatty acid oxidation with high fat and lactate reflected increased availability of exogenous and endogenous fats for respiration, as evidenced by increased long-chain fatty acyl-CoA esters (LCFA-CoAs) and by an increased contribution of triglycerides to total β-oxidation. Triglyceride turnover (synthesis and degradation) also appeared to increase. Elevated LCFA-CoAs caused high total β-oxidation despite increased malonyl-CoA. The resulting bottleneck at mitochondrial uptake of LCFA-CoAs stimulated triglyceride synthesis. Our results suggest the following. First, both malonyl-CoA and LCFA-CoAs determine total fatty acid oxidation in heart. Second, concomitant stimulation of peripheral glycolysis and lipolysis should improve cardiac energy homeostasis during exercise. We speculate that high lactate contributes to the salutary effect by bypassing the glycolytic block imposed by fatty acids, acting as an anaplerotic substrate necessary for high tricarbocylic acid cycle flux from fatty acid-derived acetyl-CoA.

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Early mortality in elderly patients undergoing treatment for multiple myeloma in real-world practice

Journal of International Medical Research ◽

10.1177/0300060518757640 ◽

2018 ◽

Vol 46 (6) ◽

pp. 2230-2237

Author(s):

Jun Xia ◽

Lingling Wang ◽

Xin Zhou ◽

Jing Wang ◽

Huan Wang ◽

...

Keyword(s):

Multiple Myeloma ◽

Lactate Dehydrogenase ◽

Elderly Patients ◽

Real World ◽

Staging System ◽

Early Mortality ◽

Stage Iii ◽

Newly Diagnosed ◽

International Staging System ◽

High Lactate

Objectives This study was performed to analyze the risk factors for early mortality (EM) in elderly patients undergoing treatment for multiple myeloma (MM) in real-world clinical practice. Methods Retrospective data from 108 elderly patients who were newly diagnosed with MM from January 2007 to July 2015 were analyzed in a single hematology center. EM was defined as death of any cause within 12 months after diagnosis. A multivariate regression model was used to evaluate EM. Results EM occurred in 16 (14.8%) elderly patients with newly diagnosed MM. The most common cause of death was infection (10/16, 62.5%). In the multivariate analysis, only an age of ≥75 years, International Staging System (ISS) stage III disease, and high lactate dehydrogenase concentration were significantly and independently associated with EM. Conclusion Our results suggest that infection is the leading cause of EM in elderly patients with MM. An age of ≥75 years, ISS stage III disease, and a high lactate dehydrogenase concentration are significant predictors of EM. We should further target this higher-risk patient population to define personalized therapy with which to improve outcomes.

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