Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients

Gunnerson, Kyle J.; Saul, Melissa; He, Shui; Kellum, John A.

doi:10.1186/cc3987

Cited by 306 publications

(115 citation statements)

References 35 publications

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“…Lactic acidosis, on the other hand, may also be associated with major metabolic dysregulation, tissue hypoperfusion, the effects of certain drugs or toxins, congenital abnormalities in carbohydrate metabolism, or a markedly increased transient metabolic demand [5, 6]. …”

Section: Introductionmentioning

confidence: 99%

Hyperlactatemia and the Outcome of Type 2 Diabetic Patients Suffering Acute Myocardial Infarction

Aleksandar¹,

Perić²,

Marković-Jovanović³

et al. 2016

Journal of Diabetes Research

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Background. Increased lactate production is frequent in unregulated/complicated diabetes mellitus. Methods. Three groups, each consisting of 40 patients (type 2 diabetics with myocardial infarction, DM+AMI, nondiabetics suffering myocardial infarction, MI, and diabetics with no apparent cardiovascular pathology, DM group), were tested for pH, serum bicarbonate and electrolytes, blood lactate, and CK-MB. Results. Blood lactate levels were markedly higher in AMI+DM compared to MI group (4.54 ± 1.44 versus 3.19 ± 1.005 mmol/L, p < 0.05); they correlated with the incidence of heart failure (ρ = 0.66), cardiac rhythm disorders (ρ = 0.54), oxygen saturation (ρ = 0.72), CK-MB levels (ρ = 0.62), and poor short-term outcome. Lactic acidosis in DM+AMI group was not always related to lethal outcome. Discussion. The lactate cutoff value associated with grave prognosis depends on the specific disease. While some authors proposed cutoff values ranging from 0.76 to 4 mmol/L, others argued that only occurrence of lactic acidosis may be truly predictive of lethal outcome. Conclusion. Both defective glucose metabolism and low tissue oxygenation may contribute to the lactate production in diabetic patients with acute myocardial infarction; high lactate levels indicate increased risk for poor outcome in this population comparing to nondiabetic patients. The rise in blood lactate concentration in diabetics with AMI was associated with increased incidence of heart failure, severe arrhythmias, cardiogenic shock, and high mortality rate.

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Section: Introductionmentioning

confidence: 99%

Hyperlactatemia and the Outcome of Type 2 Diabetic Patients Suffering Acute Myocardial Infarction

Aleksandar¹,

Perić²,

Marković-Jovanović³

et al. 2016

Journal of Diabetes Research

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“…Kaplan and Kellum 12 reported that SIG is a better predictor of mortality compared to AG observed , AG calculated , BE and lactate concentration in critically ill patients. Gunnerson et al 13 also found that lactate concentration and SIG is a better predictor of mortality compared to BE and AG corrected in critically ill patients. In contrast, Rocktaeschel et al 10 found that none of these parameters observed (AG observed , AG calculated , BDE gap , SIG) could be used as predictor of mortality in these patients.…”

Section: Introductionmentioning

confidence: 95%

Correlation Between Acid-base Balance Parameters and Lactate Concentration with the Outcome in Critically Ill Patients with Metabolic Acidosis

Yaswir¹,

Efrida²,

Liliriawati³

2017

J. of Medical Sciences

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Henderson-Hasselbach equation (the basic calculation for Base Excess/BE and Anion Gap/AG), lactate concentration and Stewart modified equation (Base Defisit/Excess gap (BDE gap ) and Strong Ion Gap (SIG)) are the parameters frequently used by clinicians in order to determine the severity of metabolic acidosis in critically ill patients. The state of metabolic acidosis correlates significantly with poor outcome (mortality). Different methods were used to diagnose metabolic acidosis. The aim of this study was to analyze the correlation between acid-base balance parameters (BE, AG observed , AG calculated , SIG, BDE gap ) and lactate concentration with the outcome in critically ill patients with metabolic acidosis. This study is an analytic study with cross-sectional design involving 70 critically ill patients admitted ICU (Intensive Care Unit) of M. Djamil Central Hospital Padang. The study was conducted from January-September, 2016. Blood gas analysis was measured with potentiometric and amperometric method, electrolytes level was measured with ISE (Ion selective electrode) method and albumin level was measured with a colorimetric method (Bromocresol green/BCG). Multi variate analysis with logistic regression was used to determine which acid-base balance parameters strongly correlates with patient outcome based on odd ratio value more than 1 (OR>1). There were 33 male patients (47%) and 37 female patients (53%). Their ages varied in the range 18-81 years-old (SD 46.3±17.9) and mostly post operative (87%). The mortality rate reached the number of 33%. Logistic regression analysis showed the OR value for BE, AG observed , AG calculated , SIG, BDE gap and lactate were 0.859 (95% CI, 0.692-1.065), 0.628 (95% CI, 0.447-0.881), 1.470 (95% CI, 0.001-1.596), 0.892 (95% CI, 0.486-1.639), 1.785 (95% CI, 1.267-2.514) and 1.01 (95% CI, 0.10-1.96), respectively. All of the acid-base balance parameters and lactate concentration measured were correlated with the outcome of critically ill patients with metabolic acidosis and strong ion gap (SIG) is the best predictor of outcome in these patients.

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“…Acute acidosis is associated with impaired cellular function and an increase in morbidity and mortality (Gunnerson et al, 2006). This cellular dysfunction is related to a decrease in pH primarily of the interstitial and cellular compartments rather than that of systemic blood (Kraut and Madias, 2012).…”

Section: Introductionmentioning

confidence: 99%

Treatment of Acidified Blood Using Reduced Osmolarity Mixed-Base Solutions

Mason

Kraut

2016

Front. Physiol.

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We hypothesize that reduced osmolarity mixed-base (ROMB) solutions can potentially serve as customizable treatments for acidoses, going beyond standard solutions in clinical use, such as 1.0 M sodium bicarbonate. Through in silico quantitative modeling, by treating acidified canine blood using ROMB solutions, and by performing blood-gas and optical microscopy measurements in vitro, we demonstrate that ROMB solutions having a high proportion of a strong base, such as disodium carbonate or sodium hydroxide, can be effective in reducing carbon dioxide pressure PCO2 while raising pH and bicarbonate ion concentration without causing significant osmotic damage to red blood cells, which can occur during rapid administration of hypertonic solutions of weak bases. These results suggest that a ROMB solution, which is composed mostly of a strong base, could be administered in a safe and effective manner, when compared to a hypertonic solution of sodium bicarbonate. Because of the reduced osmolarity and the customizable content of strong base in ROMB solutions, this approach differs from prior approaches involving hypertonic solutions that only considered a single molar ratio of strong to weak base. Our calculations and measurements suggest that custom-tailored ROMB solutions merit consideration as potentially efficacious treatments for specific types of acidosis, particularly acute metabolic acidosis and acute respiratory acidosis.

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Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients

Cited by 306 publications

References 35 publications

Hyperlactatemia and the Outcome of Type 2 Diabetic Patients Suffering Acute Myocardial Infarction

Hyperlactatemia and the Outcome of Type 2 Diabetic Patients Suffering Acute Myocardial Infarction

Correlation Between Acid-base Balance Parameters and Lactate Concentration with the Outcome in Critically Ill Patients with Metabolic Acidosis

Treatment of Acidified Blood Using Reduced Osmolarity Mixed-Base Solutions

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