Lactate and Pyruvate Concentrations, and Acid-Base Balance of Cerebrospinal Fluid in Experimentally Induced Intracerebral and Subarachnoid Hemorrhage in Dogs

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Abstract• Lactate and pyruvate concentrations and acid-base balance in cerebrospinal fluid (CSF) and arterial blood were determined in patients with intracranial hemorrhages (28 subarachnoid hemorrhages and 15 intracerebral hemorrhages).A greater increase in CSF lactate and lactate-pyruvate ratio (L/P ratio) was observed in patients with impairment of consciousness, focal neurological deficits, poor prognosis, or CSF pressures higher than 300 mm H 2 O. A combination of CSF lactate greater than 2.5 mM per liter, L/P ratio above 20, bicarbonate less than 20.4 mEq per liter, pH below 7.276, or arterial PCO2 below 31.5 mm Hg seems to indicate a poor prognosis from intracranial hemorrhage.The mechanism of hyperventilation in acute cerebrovascular diseases and of CSF pH regulation in acid-base disturbances was also discussed.

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confidence: 62%

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confidence: 80%

Section: Introductionmentioning

confidence: 99%

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Cerebrospinal Fluid and Arterial Lactate, Pyruvate and Acid-Base Balance in Patients With Intracranial Hemorrhages

Fujishima

Sugi

Choki

et al. 1975

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“…All animals in this study were alert and moving about in a relatively normal fashion prior to each anesthesia suggesting that the arterial blood gases reflect acute changes related to anesthesia and not an equilibrium situation. Sugi, et al 22 found a small increase in L / P ratio in the CSF in dogs four hours after SAH which was not significantly different from three control animals until at least five hours after onset. Our results agree with their findings, but we believe that one cannot conclude, as these authors did, that this small increase in the L / P ratio, even if significant, is due to decreased cerebral blood flow, as it may just as well relate to a non-hypoxic lactacidosis mediated by a fall in the phosphate potential."…”

Section: M1mentioning

confidence: 88%

Differentiation of early subarachnoid hemorrhage from traumatic lumbar puncture.

Shuttleworth¹,

Parker²,

Wise³

et al. 1977

SUMMARYThe problem of early differentiation of "traumatic tap" from subarachnoid hemorrhage (SAH) was studied in the rabbit by determining the changes in percentage of hemolysis and in lactate concentrations in CSF within the first twenty-four hours following induced SAH. The 0.3 to 7% hemolysis which occurred was relatively independent both of the time following SAH and of the number of red blood cells (rbc) in the cerebrospinal fluid (CSF).There was, on the other hand, a significant and time-dependent increase in CSF lactate concentration early after SAH, suggesting the potential clinical value of the detection of increased lactate with a relatively normal lactate/pyruvate ratio in hemorrhagic CSF. Until this can be evaluated in human subjects, however, determination of the rbc counts or total hemoglobin concentrations in serially collected samples of CSF remains the best clinical method.HOW TO DISTINGUISH true subarachnoid hemorrhage (SAH) from accidental blood contamination of the cerebrospinal fluid (CSF) at lumbar puncture, or so-called "traumatic tap," has been investigated for many years, and a number of clinically useful methods have been proposed. Unfortunately, many instances are encountered in which existing methods fail; these tend to be found in patients whose neurologic illness has been present only a few hours and in whom the need for a prompt diagnosis is greatest. Since the crucial difference between true SAH and "traumatic tap" is the length of time the blood has been present in the CSF, we considered several time-dependent processes for investigation, and finally selected two for study.Tourtellotte et al. 1 stated that 0.5 to 3% hemolysis occurs soon after red blood cells (rbc's) are introduced into the CSF and that essentially no further hemolysis occurs for at least six hours if the sample is stored at room temperature or at 4°C. Others found previously that incubation at 37°C resulted in progressive hemolysis which was easily detectable at one-two hours.2 This suggests that progressive hemolysis also occurs with time after SAH, which might be considered to be similar to 37° incubation, but a maximum of 3% hemolysis might be found following a "traumatic tap" providing the sample is kept between 4°C and room temperature for less than 6 hours prior to measurement. We elected to test this hypothesis as one possible approach to the problem of differentiating recent SAH from traumatic lumbar puncture.A second hypothesis which seemed clinically feasible is based upon the fact that incubated red blood cells produce lactate as a result of the absence of an aerobic glycolytic pathway.8 If other sources of lactate can be excluded, lactate concentration in hemorrhagic CSF should increase as a function of time following the onset of a subarachnoid hemorrhage, 4 -• whereas the lactate concentration in the spinal fluid obtained from a "traumatic tap" should be identical with that of uncontaminated fluid if determined immediately.Preliminary work involving in vitro incubation of autologous rbc's in CSF of...

“…The internal jugular venous O 2 content of the patients with marked disturbances of consciousness following SAH tended to increase in this study, but this change was not consistent and could not be considered characteristic. T. Sugi et al 18 reported that an increase in CSF lactate with a concomitant rise in CSF lactate/pyruvate ratio is a useful indicator of brain tissue hypoxia, even when the CSF is hemorrhagic. It is well known that brain hypoxia induces the lactic acidosis and accelerating glycolysis.…”

Section: Discussionmentioning

confidence: 99%

Body fluid oxygen tension and prognosis in patients with ruptured aneurysm.

Kishikawa¹,

Iwatsuki²,

Fujimoto³

et al. 1979

SUMMARY Body fluid gas pressure and electrolytes of patients with ruptured aneurysm were continuously analyzed. Intracranial pressure (ICP) was regulated at the level of 120-100 mm H 2 O by cerebral ventricular drainage. There was no significant change in the pH, Pco 2 , Hco;, Na + , K + , Ca + + in the cerebrospinal fluid (CSF) of patients with slight or moderate disturbance of consciousness (lethargic-drowsy state). The P C5f o 2 of the patients with marked disturbances of consciousness (semicoma-coma) was significantly low. P c »rO 2 of the patients with cerebral vasospasm was significantly lower than for those without vasospasms. P C8 rO 2 /Pao 2 was 0.27 ± 0.01 in the patients with vasospasm and 0.50 ± 0.01 in those with vasospasm. P C8f o 2 tended to decrease in patients with markedly bloody CSF. When the bloody CSF was cleared by ventricular drainage, P CBf o 2 increased. P CB fO 2 did not return to a normal value in the patients with marked disturbances of consciousness despite sufficient arterial oxygen tension. This suggests that P car o 2 and P CBf o 3 /Pao 2 should provide a convenient index for the prognosis of patients with ruptured aneurysm.