Abstract
BackgroundPlasma lactate concentrations and their trends over time are used for clinical prognosis, and to guide treatment, in critically ill patients. Although heavily relied upon for clinical decision-making, lactate kinetics of these patients is sparsely studied.AimTo establish and validate a feasible method to study lactate kinetics in critically ill patients.MethodsHealthy volunteers (n = 6) received a bolus dose of 13C-labeled lactate (20 μmol/kg body weight), and 43 blood samples were drawn over 2 h to determine the decay in labeled lactate. Data was analyzed using non-compartmental modeling calculating rates of appearance (Ra) and clearance of lactate. The area under the curve (AUC) was calculated using a linear-up log-down trapezoidal approach with extrapolation beyond 120 min using the terminal slope to obtain the whole AUC. After evaluation, the same protocol was used in an unselected group of critically ill patients (n = 10).ResultsRa for healthy volunteers and ICU patients were 12.8 ± 3.9 vs 22.7 ± 11.1 μmol/kg/min and metabolic clearance 1.56 ± 0.39 vs 1.12 ± 0.43 L/min, respectively. ICU patients with normal lactate concentrations showed kinetics very similar to healthy volunteers. Simulations showed that reducing the number of samples from 43 to 14 gave the same results. Our protocol yielded results on lactate kinetics very similar to previously published data using other techniques.ConclusionThis simple and user-friendly protocol using an isotopically labeled bolus dose of lactate was accurate and feasible for studying lactate kinetics in critically ill ICU patients.Trial registrationANZCTR, ACTRN12617000626369, registered 8 March 2017. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372507&isReview=true
Highlights
Plasma lactate concentrations and their trends over time are used for clinical prognosis, and to guide treatment, in critically ill patients
The 13C-lactate bolus resulted in decay curves that allowed for calculations of the area under the curve (AUC) (Fig. 1 and Additional file 2)
Since 13C-lactate levels had not returned to baseline at 120 min, the terminal slope was estimated and the whole extrapolated AUC used for kinetic calculations
Summary
Plasma lactate concentrations and their trends over time are used for clinical prognosis, and to guide treatment, in critically ill patients. Heavily relied upon for clinical decision-making, lactate kinetics of these patients is sparsely studied. The correlation between elevated plasma lactate concentrations and in-hospital mortality is firmly established in both intensive care and emergency department settings. 1 h in suspected sepsis [9] These relationships are most thoroughly studied in septic patients, but similar correlations are shown in other conditions as well [10]. Reports on lactate metabolism and kinetics in ICU patients are sparse. This may be because of a common misconception that lactate is the end product of anaerobic metabolism during hypoxia.
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