Lactate and glucose metabolism in severe sepsis and cardiogenic shock.

Détails

ID Serval
serval:BIB_1F2581A3B480
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Lactate and glucose metabolism in severe sepsis and cardiogenic shock.
Périodique
Critical Care Medicine
Auteur(s)
Revelly J.P., Tappy L., Martinez A., Bollmann M., Cayeux M.C., Berger M.M., Chioléro R.L.
ISSN
0090-3493
Statut éditorial
Publié
Date de publication
2005
Peer-reviewed
Oui
Volume
33
Numéro
10
Pages
2235-2240
Langue
anglais
Résumé
OBJECTIVE: To evaluate the relative importance of increased lactate production as opposed to decreased utilization in hyperlactatemic patients, as well as their relation to glucose metabolism. DESIGN: Prospective observational study. SETTING: Surgical intensive care unit of a university hospital. PATIENTS: Seven patients with severe sepsis or septic shock, seven patients with cardiogenic shock, and seven healthy volunteers. INTERVENTIONS: C-labeled sodium lactate was infused at 10 micromol/kg/min and then at 20 micromol/kg/min over 120 mins each. H-labeled glucose was infused throughout. MEASUREMENTS AND MAIN RESULTS: Baseline arterial lactate was higher in septic (3.2 +/- 2.6) and cardiogenic shock patients (2.8 +/- 0.4) than in healthy volunteers (0.9 +/- 0.20 mmol/L, p < .05). Lactate clearance, computed using pharmacokinetic calculations, was similar in septic, cardiogenic shock, and controls, respectively: 10.8 +/- 5.4, 9.6 +/- 2.1, and 12.0 +/- 2.6 mL/kg/min. Endogenous lactate production was determined as the initial lactate concentration multiplied by lactate clearance. It was markedly enhanced in the patients (septic 26.2 +/- 10.5; cardiogenic shock 26.6 +/- 5.1) compared with controls (11.2 +/- 2.7 micromol/kg/min, p < .01). C-lactate oxidation (septic 54 +/- 25; cardiogenic shock 43 +/- 16; controls 65 +/- 15% of a lactate load of 10 micromol/kg/min) and transformation of C-lactate into C-glucose were not different (respectively, 15 +/- 15, 9 +/- 18, and 10 +/- 7%). Endogenous glucose production was markedly increased in the patients (septic 14.8 +/- 1.8; cardiogenic shock 15.0 +/- 1.5) compared with controls (7.2 +/- 1.1 micromol/kg/min, p < .01) and was not influenced by lactate infusion. CONCLUSIONS: In patients suffering from septic or cardiogenic shock, hyperlactatemia was mainly related to increased production, whereas lactate clearance was similar to healthy subjects. Increased lactate production was concomitant to hyperglycemia and increased glucose turnover, suggesting that the latter substantially influences lactate metabolism during critical illness.
Mots-clé
Adult, Case-Control Studies, Glucose, Humans, Lactic Acid, Oxidation-Reduction, Prospective Studies, Sepsis, Shock, Cardiogenic, Sodium Lactate
Pubmed
Web of science
Création de la notice
24/01/2008 13:36
Dernière modification de la notice
20/08/2019 12:55
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