Abstract
Hyperosmolar lactate-based solutions have been used for fluid resuscitation in ICU patients. The positive effects observed with these fluids have been attributed to both lactate metabolism and the hypertonic nature of the solutions. In a recent issue of Critical Care, Duburcq and colleagues studied three types of fluid infused at the same volume in a porcine model of endotoxic shock. The control group was resuscitated with 0.9% NaCl, and the two other groups received either hypertonic sodium-lactate or hypertonic sodium-bicarbonate. The two hypertonic fluids proved to be more effective than 0.9% NaCl for resuscitation in this model. However, some parameters were more effectively corrected by hypertonic sodium-lactate than by hypertonic sodium-bicarbonate, suggesting that lactate metabolism was beneficial in these cases.
Highlights
Hyperosmolar lactate-based solutions have been used for fluid resuscitation in ICU patients
When pyruvate does not enter mitochondria, it leaves the cell in which it was produced to enter another one where it is converted into glucose or catabolized to allow ATP production
In ICU patients, both blood glucose [1] and lactate [2] concentrations positively correlate with the severity of illness
Summary
Hyperosmolar lactate-based solutions have been used for fluid resuscitation in ICU patients. When pyruvate does not enter mitochondria, it leaves the cell in which it was produced to enter another one where it is converted into glucose (gluconeogenesis) or catabolized to allow ATP production. In ICU patients, both blood glucose [1] and lactate [2] concentrations positively correlate with the severity of illness.
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