Effect of bicarbonate and lactate buffer on glucose and lactate metabolism during hemodiafiltration in patients with multiple organ failure.

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Serval ID
serval:BIB_A3D0A924C3C5
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Effect of bicarbonate and lactate buffer on glucose and lactate metabolism during hemodiafiltration in patients with multiple organ failure.
Journal
Intensive care medicine
Author(s)
Bollmann M.D., Revelly J.P., Tappy L., Berger M.M., Schaller M.D., Cayeux M.C., Martinez A., Chioléro R.L.
ISSN
0342-4642
Publication state
Published
Issued date
2004
Peer-reviewed
Oui
Volume
30
Number
6
Pages
1103-1110
Language
english
Notes
Publication types: Clinical Trial ; Comparative Study ; Journal Article ; Randomized Controlled Trial - Publication Status: ppublish
Abstract
OBJECTIVE: To compare the effects of sodium bicarbonate and lactate for continuous veno-venous hemodiafiltration (CVVHDF) in critically ill patients. DESIGN AND SETTINGS: Prospective crossed-over controlled trial in the surgical and medical ICUs of a university hospital. PATIENTS: Eight patients with multiple organ dysfunction syndrome (MODS) requiring CVVHDF. INTERVENTION: Each patient received the two buffers in a randomized sequence over two consecutive days. MEASUREMENTS AND RESULTS: The following variables were determined: acid-base parameters, lactate production and utilization ((13)C lactate infusion), glucose turnover (6,6(2)H(2)-glucose), gas exchange (indirect calorimetry). No side effect was observed during lactate administration. Baseline arterial acid-base variables were equal with the two buffers. Arterial lactate (2.9 versus 1.5 mmol/l), glycemia (+18%) and glucose turnover (+23%) were higher in the lactate period. Bicarbonate and glucose losses in CVVHDF were substantial, but not lactate elimination. Infusing (13)C lactate increased plasma lactate levels equally with the two buffers. Lactate clearance (7.8+/-0.8 vs 7.5+/-0.8 ml/kg per min in the bicarbonate and lactate periods) and endogenous production rates (14.0+/-2.6 vs 13.6+/-2.6 mmol/kg per min) were similar. (13)C lactate was used as a metabolic substrate, as shown by (13)CO(2) excretion. Glycemia and metabolic rate increased significantly and similarly during the two periods during lactate infusion. CONCLUSION: Lactate was rapidly cleared from the blood of critically ill patients without acute liver failure requiring CVVHDF, being transformed into glucose or oxidized. Lactate did not exert undesirable effects, except moderate hyperglycemia, and achieved comparable effects on acid-base balance to bicarbonate.
Keywords
Acid-Base Equilibrium, Aged, Analysis of Variance, Blood Glucose, Buffers, Cross-Over Studies, Female, Hemodiafiltration, Humans, Lactic Acid, Male, Metabolic Clearance Rate, Middle Aged, Multiple Organ Failure, Prospective Studies, Sodium Bicarbonate, Water-Electrolyte Balance
Pubmed
Web of science
Open Access
Yes
Create date
24/01/2008 13:36
Last modification date
01/10/2019 6:19
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