Serum Lactic Acid Levels Research Articles

Combining the serum lactic acid level and the lactate clearance rate into the CLIF-SOFA score for evaluating the short-term prognosis of HBV-related ACLF patients

ABSTRACT Background Acute-on-chronic liver failure due to hepatitis B virus infection is a subtype of liver failure. The aim of the current study was to investigate the clinical significance of serum lactic acid in combination with the Chronic Liver Failure-Sequential Organ Failure Assessment score (CLIF-SOFA) for evaluating the short-term prognosis of HBV-related ACLF patients. Research design and methods The serum lactic acid level, the score model for end-stage liver disease (MELD), as well as the CLIF-SOFA of inpatients with HBV-related ACLF who were admitted to the Liver Disease Center of the First Affiliated Hospital of Fujian Medical University between 2009 and 2017 were analyzed. Results Three hundred and ninety-one HBV-related ACLF inpatients were measured. In the survival group, the lactate clearance rate measured over the course of 1 week post-admission was significantly higher than that measured for the death group. The area under the curve (AUC) for predicting the prognosis of HBV-related ACLF patients in short-term (within 3-month) with a baseline lactic acid level was 0.776. Conclusions Prediction performance of the short-term prognosis of HBV-related ACLF patients by combining the lactic acid level into the CLIF-SOFA score was significantly improved in comparison to using the CLIF-SOFA score alone.

Reduction of early inpatient transfers and rapid response team calls after implementation of an emergency department intake huddle process

Patients admitted to the hospital and requiring a subsequent transfer to a higher level of care have increased morbidity, mortality and length of stay compared with patients who do not...

Structural characterization, erythrocyte protection, and antifatigue effect of antioxidant collagen peptides from tilapia (Oreochromis nilotica L.) skin.

Tilapia (Oreochromis nilotica L.) skin collagen is a meritorious commercial resource to be exploited. The purpose of this study was to obtain, evaluate, and characterize tilapia skin collagen-derived antioxidant hydrolysates (TSCP). AAPH-induced erythrocyte hemolysis assay and antifatigue test in mice were implemented. It was indicated that TSCP treatment at 1 mg mL-1 could effectively attenuate AAPH-induced erythrocyte hemolysis rate from 56.35 ± 2.46% to 18.78 ± 2.48% (p < 0.01). A 2.5 mg/(10 g d) dose of TSCP intragastric administration could observably prolong the exhaustive swimming time of the loaded mice and its mechanism was multiple, including the decrease in the levels of serum lactic acid, serum urea nitrogen, and creatine kinase activity, thus improving the contents of liver and muscle glycogen and endogenous SOD activity. Five oligopeptides from the antioxidant fraction were identified as Gly-Hyp, Glu-Asp, Asp-Hyp-Gly, Glu-Pro-Pro-Phe, and Lys-Pro-Phe-Gly-Ser-Gly-Ala-Thr and then synthesized. Among them, the octapeptide exhibited the strongest antioxidant capacity. Therefore, tilapia skin-derived collagen is a meritorious edible resource for producing commercial functional foods, thus helping to scavenge radicals, protecting erythrocytes, and further resisting fatigue.

Anti-fatigue Effect of Anwulignan on Aging Mice

Objective:To observe the anti-fatigue effect of Anwulignan(AN) on D-galactose-induced aging mice. Methods:ICR male mice were randomly divided into four groups,named the blank control group(CON),the model group(MOD),low-dose group(AN,1 mg/kg),and high-dose group(AN,4 mg/kg).After 30 min of administration of Anwulignan or solvent,each group was injected subcutaneously of normal saline or D-galactose,once a day for 6 weeks. By using fatigue rotation bar test and forelimb grip test,exercise endurance of aging mice was observed,the urea nitrogen,lactic acid,lactate dehydrogenase,creatine kinase,and superoxidase in skeletal muscle tissue,and malondialdehyde levels were detected by chemical chemical chromatometry. Results:Compared with the MOD group,the low-dose AN group and the high-dose AN group prolonged the rod rotation time of mice by 37% and 67%(P<0.05),and 55%(P<0.05) and 89%(P<0.01) of forelimb grip value.The grip strength of the forelimbs of mice showed that the exercise endurance of mice treated with different doses of AN significantly increased(P<0.05 or P<0.01).At the same time,the oxidation and fatigue indicators showed that high-dose AN,the effect of the lower dose AN group was more significant. The oxidation parameter contents of superoxide enzyme increased by 38%(P<0.01),and the content of malondialdehyde decreased by 14%(P<0.05). The fatigue parameter indicators decreased the levels of serum urea nitrogen and lactic acid by 15%(P<0.05)) and 21%(P<0.05),lactate dehydrogenase and creatine kinase activity were reduced by 22%(P<0.01) and 12%(P<0.05).Conclusion:AN had anti-fatigue effect in aging mice induced by D-galactose.This study would provide a experimental basis for the further development of anti-aging and anti-fatigue drugs and health foods.

Oral Administration of Okara Soybean By-Product Attenuates Cognitive Impairment in a Mouse Model of Accelerated Aging.

The microbiota–gut–brain axis has attracted increasing attention in the last decade. Here, we investigated whether okara, a soybean by-product rich in dietary fiber, can attenuate cognitive impairment in senescence-accelerated mouse prone 8 (SAMP8) mice by altering gut microbial composition. Mice were fed either a standard diet, or a diet containing okara (7.5% or 15%, w/w) for 26 weeks. In the memory test, the 7.5% okara-fed mice showed a longer step-through latency and the 15% okara-fed mice had a short escape latency compared with control mice. The 15% okara-fed mice displayed decreased body weight, increased fecal weight, and altered cecal microbiota composition compared with the control group; however, there was no significant difference in the serum lactic acid and butyric acid levels among these mice groups. The 7.5% okara-fed mice had significantly higher NeuN intensity in the hippocampus compared with control mice. Furthermore, a decrease in inflammatory cytokine TNF-α and an increase in brain-derived neurotrophic factor (BDNF) was observed in the 7.5% okara-fed group. The expression of synthesizing enzyme of acetylcholine was increased by the okara diets, and the acetylcholine level in the brain was higher in the 7.5% okara-fed group than in the control. These suggest that oral administration of okara could delay cognitive decline without drastically changing gut microbiota.

Effect of Compression Modalities for Recovery on Wrestlers Biomarkers in One Day Tournament

Aim: investigate the effect of different compression modalities as to recovery enhancement on some biomarkers in wrestlers. Methods: Serum creatinine, lactic acid and glucose level were tested in elite wrestlers before match up, 3minuts post-match up and 19 minutes after applying recovery compression model. Results: showed insignificant differences between pre-post 3min tests, among research groups due to sample equality, 3min and 19min post match up tests showed efficacy of compression technique in enhancing recovery in sake of 160/20 mmHg compression modality with enhancement percentage of 16.614% for serum creatinine, 43.214% for lactic acid and 22.505% for glucose level. Conclusion: compression band with 160/20 mmHg exceeds recovery after match up

The significance of serum HMGB1 level in humans with acute paraquat poisoning

High-mobility group box 1 (HMGB1) mediates acute lung injury in a mouse model of paraquat poisoning. However, published reports showing a clinically relevant association between HMGB1 and paraquat exposure are lacking. The objective of the present study was to investigate the potential role of serum HMGB1 level as a prognostic marker of mortality in patients with paraquat poisoning in a clinical setting. This retrospective observational cohort study included a convenience sample of 92 patients with acute paraquat poisoning admitted to the emergency room (ER) of The First Hospital of Jilin University between January 2014 and December 2016. Baseline serum HMGB1 levels and other laboratory parameters were measured on admission. Cumulative incidence of mortality during the first 30 days after admission was 50% (n = 46/92). Serum HMGB1 levels were higher in fatalities than survivors (P = 0.015), 30-day mortality increased with increasing baseline serum HMGB1 level (P < 0.001), and higher serum HMGB1 levels were associated with an increase in 30-day mortality on Kaplan-Meier analysis. Multivariate Cox regression analysis identified baseline serum HMGB1 levels, white blood cell count, and serum lactic acid levels as independent prognostic markers of 30-day mortality. These data suggest that serum HMGB1 levels measured on admission to the ER are an independent predictor of 30-day mortality in patients with acute paraquat poisoning.

Effect of compression modalities for recovery on wrestlers' biomarkers in one day tournament

The aim of the study was to investigate the effect of different compression modalities as to recovery enhancement on some biomarkers in wrestlers. Serum creatinine, lactic acid and glucose level were tested in elite wrestlers before a match-up, 3 minutes post-match up and 19 minutes after applying recovery compression model. The results showed insignificant differences between pre-post 3-minute tests among research groups due to sample equality, 3-minute and 19-minute post match-up tests showed efficacy of compression technique in enhancing recovery in sake of 160/20 mmHg compression modality with enhancement percentage of 16.614% for serum creatinine, 43.214% for lactic acid and 22.505% for glucose level. The compression band with 160/20 mm Hg exceeds recovery after match-up.

Associations with the In-Hospital Survival Following Extracorporeal Membrane Oxygenation in Adult Acute Fulminant Myocarditis.

Background: Acute fulminant myocarditis (AFM) is a serious disease that progresses rapidly, and leads to failing respiratory and circulatory systems. When medications fail to reverse the patient’s clinical course, extracorporeal membrane oxygenation (ECMO) is considered the most effective, supportive and adjunct strategy. In this paper we analyzed our experience in managing AFM with ECMO support. Methods: During October 2003 and February 2017, a total of 35 patients (≥18 years) were enrolled in the study. Twenty patients survived, and another 15 patients expired. General demographics, the hemodynamic condition, timing of ECMO intervention, and laboratory data were compared for the survival and non-survival groups. Univariate and multivariate Cox regression analyses were performed to identify the associations with in-hospital mortality following ECMO use in this situation. Results: The survival rate was 57.1% during the in-hospital period. The average age, gender, severity of the hemodynamic condition, and cardiac rhythm were similar between the survival and non-survival groups. Higher serum lactic acid (initial and 24 h later), higher peak cardiac biomarkers, higher incidence of acute kidney injury and the need for hemodialysis were noted in the non-survival group. Higher 24-h lactic acid levels and higher peak troponin-I levels were associated with in-hospital mortality. Conclusions: When ECMO was used for AFM, related cardiogenic shock and decompensated heart failure, higher peak serum troponin-I levels and 24-h serum lactic acid levels following ECMO use were independently associated with in-hospital mortality.

A case of late‐onset Leber's hereditary optic neuropathy with elevated serum lactic acid and pyruvic acid levels by cycle ergometer exercise

AbstractLeber's hereditary optic neuropathy (LHON) is a mitochondrial disorder characterized by acute or subacute bilateral vision loss. We describe a female who experienced visual impairment at the age of 75 years. Genetic analysis of peripheral blood leukocytes revealed a point mutation (11778G&gt;A) in MTND4 encoded by mitochondrial DNA. The most distinctive feature of our patient was the elevation of serum LA and PA levels and the LA/PA ratio by cycle ergometer exercise without clinical or pathological skeletal muscle involvement. Also, droplet digital PCR (ddPCR) showed that mutation fractions of m.11778G&gt;A in peripheral blood and muscle sample were higher than 99.9%, indicating “homoplasmy”. Although no cases of LHON with clinical impairment of skeletal muscle have been reported, subclinical mitochondrial dysfunction has been reported. We concluded that the ergometer test sensitively detected a subclinical change caused by mitochondrial respiratory chain dysfunction, showing the diversity of genotype and phenotype relationship in LHON.

Antifatigue effects of peptide isolated from sheep placenta

ObjectiveFatigue has become one of the major threats to human health in the 21st century. Traditional Chinese medicine (TCM), which proved to be safer and more effective, has become a hot spot in antifatigue research. Human placenta, also called “Ziheche”, has drawn great attention in the antifatigue effect since the Tang dynasty. However, the shortage of human placenta restricts wide usage of it. According to the theory of TCM, sheep placenta (SP) also has the effect of nourishing blood, tranquilization, nourishing skin, and prolongation of life. The aim of this study was to examine the antifatigue effects of sheep placenta peptide (SPP), an extract of sheep placenta, in mice and the mechanism was also studied. MethodsPeptide from fresh SP was extracted via enzymolysis. SPP (0.13 g/kg) and soybean peptide (0.65 g/kg) were administrated orally and daily to mice for four weeks. Antifatigue effects of SPP were estimated on weight-loaded swimming test; A non-weight-loaded swimming test was conducted to elucidate underlying the mechanisms of the anti-fatigue effects. ResultsAdministration of SPP prolonged the weight-loaded swimming time in mice. In addition, SPP significantly decreased the levels of muscle malondialdehyde (MDA) and serum lactic acid (LD), and increased the activities of muscle glutathione peroxidase (GSH), and superoxide dismutase (SOD) and liver glycogen in mice after non-weight-loaded swimming test. Moreover, the electron microscope observation showed that the muscle fiber bundle ranked neatly, the H band, I band, Z line as well as M line were clear and the numbers of mitochondria was normal though some of the mitochondria were swell in SPP treated mice after non-weight-loaded swimming test. ConclusionSPP possesses potent abilities for antifatigue; Increasing the anti-oxidant activities and energy reserve as well as improving the ultrastructures in gastrocnemius muscle cells, which may be the mechanisms of SPP exerting its antifatigue effects.

Repeated Attacks of Dizziness Caused by a Rare Mitochondrial Encephalomyopathy

Cases of dizziness caused by multiple sclerosis are commonly reported, but those caused by mitochondrial encephalomyopathy have been rarely reported. Particularly, the description of eye nystagmography (ENG) using caloric and optokinetic nystagmus tests has not been reported to date. We encountered the case of a 40-year-old woman with mitochondrial encephalomyopathy who visited us with the chief complaint of dizziness. At first, we considered multiple sclerosis based on the magnetic resonance imaging (MRI) findings and dizziness. Repeated attacks of dizziness and serum lactic acid levels suggested mitochondrial encephalomyopathy. A muscle biopsy confirmed the diagnosis. ENG findings suggested central vestibular disorder of the cerebellum and brainstem. This case suggests that we should not rule out the differential diagnosis of a very rare mitochondrial encephalomyopathy in patients who experience dizziness with MRI findings indicative of multiple sclerosis.

Lactic acid as an adjuvant marker in pregnancy-associated sepsis

Background. Lactic acid level is one index which is currently actively researched for its role in pregnancy-associated sepsis (PAS). We aimed to quantify the severity of PAS using lactic acid levels. Methods. All pregnant, post-abortal (2 weeks) and postpartum women (up to 6 weeks) with clinical sepsis were enrolled as per systemic inflammatory response syndrome criteria, and lactic acid levels were estimated at admission. Severe PAS was defined as one or more organ dysfunctions due to sepsis. The severity of obstetric sepsis was graded according to number of organ failures. Results. There were 42 patients with non-severe PAS, and 58 with severe PAS. The ≥4 mmol/L lactic acid threshold had 88.10% specificity and 37.93% sensitivity for detection of severe PAS. A significant difference ( p =0.006) was found between lactic acid levels (mean (standard deviation (SD)) in cases with single OF ( n =24; 3.02 (0.92) mmol/L) v. multi-organ failure ( n =34; 3.70 (0.81) mmol/L). The mean (SD) lactic acid levels (3.76 (0.97) mmol/L) with any type of culture-positive PAS cases ( n =35) were significantly higher than in culture-negative PAS cases (2.95 (0.98); p =0.0001). Conclusions. Lactic acid level ≥4 mmol/L had reasonable specificity for severity and culture positivity in PAS. A serum lactic acid level ≥3 mmol/L was associated with more number of organ failures.

Elevated central venous pressure is associated with increased mortality in pediatric septic shock patients

BackgroundCentral venous pressure (CVP) is an important factor affecting capillary blood flow, and it is associated with poor outcomes in adult septic shock patients. However, whether a similar association exists in pediatric patients remains unclear.MethodsWe retrospectively analyzed data from patients admitted to our pediatric intensive care unit (PICU) between February 2009 and July 2015. Patients were divided into two groups—survivors and nonsurvivors—according to 28-day mortality. The associations between (a) mortality and CVP at 6, 24, 48, and 72 h after initiating treatment for established septic shock was analyzed and (b) initial serum lactic acid levels and 6-h CVP.ResultsTwo hundred twenty-six patients were included in this study, and the mortality rate was 29.6% (67 deaths, nonsurvivor group). Initial serum lactic acid levels, Pediatric Risk of Mortality (PRISM) III score, and Vasoactive–Inotropic Score (VIS) within 24 h after PICU admission were significantly higher in the nonsurvivors than in survivors (1.3 [0.9, 2.4] vs. 3.9 [1.6, 8.0] mmol/l, 11.0 [7.0, 15.0] vs. 17.0 [10.0, 21.5], 12.0 [7.0, 25.0] vs. 22.5 [8.0, 55.0], respectively with p-values < 0.001, < 0.001, and 0.009, respectively). In addition, compared to survivors, a greater percentage of nonsurvivors required mechanical ventilation (92.5% vs. 51.6%, p < 0.001) and showed a greater extent of fluid overload at 48 h after admission (3.9% vs. 1.9%, p = 0.006), along with higher 6-h CVP (10.0 [7.0, 16.0] vs. 8.0 [5.0, 11.0] mmHg, p < 0.001). Patient survival according to levels of CVP (CVP < 8 mmHg, CVP 8–12 mmHg, or CVP > 12 mmHg) showed that the CVP > 12-mmHg group had significantly greater mortality rates (50.0%, p = 0.002) than the other groups (21.3% and 27.5%). Furthermore, multivariate analysis identified significant associations of CVP > 12 mmHg, serum lactic acid levels, and the need for mechanical ventilation with mortality (OR: 2.74, 1.30, and 12.51, respectively; 95% CI: 1.11–6.72, 1.12–1.50, and 4.12–37.96, respectively).ConclusionsElevated CVP is an independent risk factor for mortality in pediatric septic shock patients.

The anti-fatigue activities of Tuber melanosporum in a mouse model.

Tuber melanosporum (TM) is an edible fungus that exhibits antioxidant and anti-tumor activity via its unique bioactive metabolites. The present study analyzed the anti-fatigue effects of TM using a BALB/c mouse model. The anti-fatigue properties of TM were evaluated by assessing the endurance of mice by performing forced swimming, rotary rod and running tests. Following 2 weeks TM treatment, hepatic and muscular ATP, and glycogen levels were increased in mice subjected to 30 min swimming, compared with controls. Similarly, levels of serum lactic acid and lactic dehydrogenase were decreased in the same group, compared with the control. Additionally, TM treatment reduced reactive oxygen species and malondialdehyde levels, and increased superoxide dismutase and glutathione peroxidase levels in the muscle, liver and/or serum. The effect of TM on hormone levels was also investigated in the present study, as different efficacies of TM were observed in male and female mice. TM treatment increased serum levels of progesterone, estradiol and testosterone in female and male mice, whereas a decrease in serum luteinizing hormone levels was only observed in females. A decrease in serum follicle-stimulating hormone levels was identified in females, whereas an increase was observed in males. The current study demonstrated that the anti-fatigue effects of TM occur via the regulation of oxidative stress, energy metabolism and hormone levels.

P852 A metabolomics approach to discover biomarkers of chronic intestinal inflammation associated with gut microbiota dysbiosis in ulcerative colitis and Celiac Disease

The effect of gut microbiota dysbiosis on human metabolome and the potential of microbial and endogenous metabolites as biomarkers of chronic intestinal inflammation (CII) are not clear. Forty ulcerative colitis (UC) patients, 43 celiac disease (CD) patients and 42 healthy volunteers (HV) were enrolled. The qRT-PCR was used for fecal microbiota assessment. Serum metabolomic assays were conducted using the GC-MS. UC patients were randomised into A1 and A2 groups and CD patients were randomised into B1 and B2 groups. A1 and B1 groups received oral calcium butyrate plus inulin for 28 days as supplement to oral mesalazine in UC or gluten-free diet (GFD) in CD. A2 and B2 groups received standard treatment or GFD. Butyrate-producing bacteria (BPB) were depleted in UC compared with HV. CD patients had lower Bifidobacterium spp. counts than HV or UC. Taxonomic dysbiosis in both UC and CD was characterised by a higher Bacteroides fragilis/Faecalibacterium prausnitzii ratio compared with HV. Significant changes in gut microbiota in both UC and CD were accompanied by changes in serum microbial metabolites levels. In UC serum lactic acid, 2-hydroxybutyric acid (2-HBA), 3-hydroxyisobutyric acid (3-HIBA), 2-hydroxyisovaleric acid (2-HIVA), 3-hydroxycinnamic acid, succinic acid (SA), benzoic acid (BA) and 4-hydroxyphenylacetic acid (4-HPAA) levels were significantly increased compared with HV. Serum levels of caproic acid, linoleic acid (LA) and eicosadienoic acid (EDA) in UC were significantly lower than in HV. Serum of CD patients showed significant increases in stearic acid (StA), 2-HIVA, SA, fumaric acid and BA compared with HV. De novo lipogenesis index (DNL) (C16:0/C18:2n-6) was significantly elevated in UC compared with both HV and CD. The ELOVL6 elongase activity index (C18:0/C16:0) and the StA/lA ratio (C18:0/C18:2n-6) in UC were significantly increased compared with HV. AA/EDA ratio (C20:4n-6/C20:2n-6) was increased in both UC and CD. Oral butyrate plus inulin significantly enhanced fecal BPB, reduced elevated B. fragilis/F. prausnitzii ratio, lowered serum pro-inflammatory SA and 2-HIVA and restored the initially lowered LA and EDA. 85% of UC patients in A1 (butyrate) group demonstrated significant improvement in rectal bleeding and stool frequency by day 14, compared with 55% in A2 group. The changes in serum metabolome, reflecting metabolic pathways disturbances (glycolysis, TCA cycle, fatty acid metabolism, ketone body metabolism, phenylalanine, tyrosine and tryptophan metabolism, microbial metabolism) are observed in both UC and CD. Some of metabolites and a new metabolomic index (AA/EDA ratio) may be considered as candidate biomarkers of CII. Oral butyrate plus inulin has a prebiotic (butyrogenic) effect, restoring BPB.

Is Serum Lactic Acid a Reliable Indicator for Diagnosing Fat Embolism Syndrome?

Introduction: The incidence of Fat Embolism Syndrome (FES) has been reported to occur in 0.5 to 3% of patients with isolated long bone fracture. FES is most commonly associated with long bone fractures, if associated with polytrauma then the chance of manifestation increases by 11%. Fat embolism is a clinical entity diagnosed mainly by Gurd’s criteria which includes clinical signs and blood parameters. There is no single blood parameter to detect FES at earliest. A high lactate level is an early sign of tissue hypoxia. In patients with femur shaft fracture tissue hypoxia is the most important cause of increased lactate levels. Increased blood lactate level is related to increased mortality. Aim: To establish the relationship between serum lactic acid and fat embolism in patients with fracture shaft of the femur. Materials and Methods: The present was a prospective study done at Kasturba Medical College Hospitals, Mangalore, Karnataka, India, on 40 patients with femur shaft fracture. Statistical analysis was done using SPSS (version 17.0). Results: In the present study, four patients out of 40 had FES (Gurd’s criteria), whose serum lactic acid was high (>25) within 72 hours of injury. Fourteen patients had elevated lactic acid (>20) but did not develop FES. All patients with FES had elevated serum lactic acid which was statistically significant (p-value 0.003), yet serum lactic acid estimation was less sensitive 28.7%. Conclusion: In conclusion serum lactic acid is specific (100%) for fat embolism but not sensitive (28.7%). By using serum lactic acid level, development of fat embolism can’t be predicted however, elevated lactic acid level will help us in risk stratification.

Lactate Level Does Not Predict Intussusception

To assess whether serum lactic acid levels can help in the diagnosis of intussusception, investigators enrolled a prospective convenience sample of

Clinical Vignettes/Case Reports-Small Intestine.

The clinical spectrum of ischemic bowel disease ranges from mild and transient injury, to bowel perforation, peritonitis and septic shock in severe cases. Clinical and radiologic findings are non-specific and seen in other gastrointestinal (GI) conditions such as infectious and inflammatory colitis, creating a diagnosis dilemma. A non-GI pathology mimicking severe ischemic bowel is even more clinically challenging. We present the unique case of a patient with features suggestive of severe ischemic bowel, who was found to have bladder necrosis during surgery. A 57 year old female with risk factors for ischemic bowel including hypertension, dyslipidemia, diabetes mellitus and End-Stage Renal Disease on hemodialysis was found unresponsive with a Glasgow Coma Scale of 3 and subsequently intubated. Chart review revealed treatment of Escherichia coli (E.coli) cystitis with bladder wall thickening on imaging (Figure 1) one year prior. On admission, her temperature was 95.5F, heart rate 102 beats per minute and blood pressure 76/55 mmHg. The rest of her physical examination was otherwise unremarkable. Laboratory findings were notable for elevated white blood count (WBC - 15.2K/mcl), increased serum lactic acid levels (4.5 mmol/l), elevated serum procalcitonin to 112.5 ng/ml and E.coli bacteremia. Abdominopelvic CT scan showed small and large bowel thickening without evidence of obstruction or perforation (Figure 2), thickening and irregularity of the bladder wall with outpouchings (Figure 3), and mild ascites. She was admitted to the Intensive care unit (ICU) for treatment of septic shock from presumed ischemic bowel and E.coli bacteremia. By day 2 of ICU admission, her clinical condition deteriorated as evidenced by persistent hypotension, worsening leukocytosis (WBC - 33.1K/mcl) and severe lactic acidosis (lactic acid - 5.2mmol/l). She had urgent exploratory laparotomy which revealed necrotic bladder. There was no evidence of bowel ischemia as initially suspected. She had partial cystectomy and pathologic analysis of resected bladder tissue confirmed necrosis without malignancy. Our patient had cystitis, likely chronic, from E.coli infection complicated by bladder necrosis and septic shock. Interestingly, her presentation on admission mimicked severe E.coli - associated bowel ischemia. This case demonstrates that even in the presence of strong risk factors for ischemic bowel disease, clinicians should always consider other potential life threatening conditions.FigureFigureFigure

ROLE OF SERUM LACTIC ACID LEVEL IN DIAGNOSING MESENTERIC BOWEL ISCHEMIA WITH THE AID OF THE CT ANGIOGRAM.

18Feb 2017 ROLE OF SERUM LACTIC ACID LEVEL IN DIAGNOSING MESENTERIC BOWEL ISCHEMIA WITH THE AID OF THE CT ANGIOGRAM. Khadijah Mohammed Ayoub , Ahmed Haitham Abduljabbar , Sara Ali Sawan , Mawaddah Tallab and Mohammad Abdulrahim Wazzan. Faculty of Medicine, King Abdulaziz University, Jeddah ,Saudi Arabia. Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.