Cerebrospinal fluid lactate: measurement of an adult reference interval

Slack, Sally; Turley, Paul; Allgar, Victoria; Holbrook, Ian

doi:10.1177/0004563215591633

Cited by 7 publications

(3 citation statements)

References 17 publications

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“…The normal level of lactate in the CSF is 2 mmol/L and not different from that in the blood. Increase in lactate above 4 mmol/L is a more specific indicator for bacterial meningitis than other CSF markers in immediate evaluation (CSF cell count, CSF glucose, and protein concentration) (Donald and Malan, 1986;Giulieri et al, 2015; Julián-Jim enez and Morales-Casado, 2016; Slack et al, 2016;Xiao et al, 2016). (Pfaller et al, 2006).…”

Section: Quantitative Csf Analysis: Cells and Chemistrymentioning

confidence: 99%

CSF in acute and chronic infectious diseases

Benninger

Steiner

2018

Handbook of Clinical Neurology

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Infections of the nervous system are an important and challenging aspect of clinical neurology. Immediate correct diagnosis enables to introduce effective therapy, in conditions that without diagnosis may leave the patient with severe neurological incapacitation and sometimes even death. The cerebrospinal fluid (CSF) is a mirror that reflects nervous system pathology and can promote early diagnosis and therapy. The present chapter focuses on the CSF findings in neuro-infections, mainly viral and bacterial. Opening pressure, protein and glucose levels, presence of cells and type of the cellular reaction should be monitored. Other tests can also shed light on the causative agent: serology, culture, staining, molecular techniques such as polymerase chain reaction. Specific examination such as panbacterial and panfungal examinations should be examined when relevant. Our chapter is a guide-text that combines clinical presentation and course with CSF findings as a usuaful tool in diagnosis of neuroinfections. ACUTE INFECTIOUS DISEASES OF THE NERVOUS SYSTEMAcute infections of the nervous system are as diverse in their clinical consequences for the patient as the variety of infectious agents causing them: from mild headaches to long-term morbidity and a threat to life. Therefore, the earliest possible diagnosis is absolutely essential. Central here stands the examination of the CSF. The correct diagnosis is often dependent on this rather simple procedure to allow diagnosis and focused antimicrobial and adjunctive therapy. This chapter deals with acute infectious diseases of the nervous system and the importance of the lumbar puncture (LP) in the diagnostic process.

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Section: Quantitative Csf Analysis: Cells and Chemistrymentioning

confidence: 99%

CSF in acute and chronic infectious diseases

Benninger

Steiner

2018

Handbook of Clinical Neurology

View full text Add to dashboard Cite

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“…The five insulin analogues listed in the study of Dayaldasani et al 1 are also structurally different from naturally secreted human insulin. They are engineered recombinant forms in which amino acids in specific locations have been altered.…”

Section: Insulin Analogues As a New Example Of Interference In Insulimentioning

confidence: 99%

“…In a recent article, Dayaldasani et al 1 carefully assessed cross-reactivity of five insulin analogues in three immunometric insulin assays. An excellent editorial 2 also highlighted this complex phenomenon as a new source of error in immunoassay.…”

Section: Insulin Analogues As a New Example Of Interference In Insulimentioning

confidence: 99%

Comment on the study ‘Cerebrospinal fluid lactate: measurement of an adult reference interval’ by Sally D Slack, Paul Turley, Victoria Allgar and Ian B Holbrook

Kelbich

Hejčl

Procházka³

et al. 2015

Ann Clin Biochem

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Measurement of lactate concentration in the cerebrospinal fluid (CSF) is useful for diagnosing an inflammatory response in the central nervous system (CNS); thus, we read the study by Slack et al. 'Cerebrospinal fluid lactate: measurement of an adult reference interval' 1 with great interest. Unfortunately, the ability of CSF lactate to predict CNS inflammation is limited. The concentration of lactate in the CSF is not influenced exclusively by the extent of anaerobic metabolism in the CSF, but also by the supply of the energy substrate (glucose). We therefore derived an equation, the so-called coefficient of energy balance (KEB), and have successfully applied it in our practice for several yearsThe KEB can be defined as the theoretical average number of molecules of adenosine triphosphate (ATP) produced from one molecule of glucose under given conditions in the CSF compartment.By investigating the molar concentrations of glucose and lactate in the CSF and calculating the KEB, we can distinguish three 'energy levels' in the CSF: (1) KEB values >28.0 indicate normal energy conditions in the CSF, but cannot rule out a possible pathological process in the CNS; (2) KEB values 428.0 indicate increased anaerobic metabolism in the CSF, which may be associated with CNS inflammation; (3) KEB values <10.0, including values below 0.0, indicate a very high level of anaerobic metabolism in the CSF, usually related to severe inflammation with an oxidative burst of phagocytes in the CNS. 2,4,5 Cytological investigations of the CSF are also of key importance in the diagnosis of CNS impairment. The combination of KEB and CSF cytology enables differentiation between less intense serous inflammations, and severe inflammations caused by an oxidative burst of neutrophil granulocytes or macrophages in the CNS.The finding of a significant number of CSF neutrophil granulocytes and a high degree of CSF anaerobic metabolism (with KEB values <10.0) is typical of purulent inflammation in the CNS, usually involving extracellular bacteria. 2,4,5 Similarly, the finding of a significant number of CSF lymphocytes or monocytesmacrophages and a high degree of anaerobic metabolism in the CSF compartment (KEB values <10.0) may signify an intense inflammatory response in the CNS with an oxidative burst of macrophages, involving intracellular bacteria, mycotic agents or cancer. 2,5Thus, our solution is not only to investigate the lactate concentrations in the CSF, but in particular to also determine the extent of anaerobic metabolism in the CSF compartment via the KEB level.

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