Effects of cardiogenic shock on lactate and glucose metabolism after heart surgery
| Autor: | Xavier Leverve, Luc Tappy, René Chioléro, Marie-Christine Cayeux, Mette M. Berger, Jean-Pierre Revelly, Philippe Gersbach |
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| Přispěvatelé: | Service de médecine intensive adulte, Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Bioénergétique fondamentale et appliquée, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Cardiovascular Surgery, Department of Adult Intensive Care Medicine and Burns Center, Institute of Physiology, Université de Lausanne (UNIL), Hamant, Sarah, Université de Lausanne = University of Lausanne (UNIL) |
| Jazyk: | angličtina |
| Rok vydání: | 2000 |
| Předmět: |
Male
MESH: Oxidation-Reduction Hydrocortisone Glucose uptake MESH: Acidosis Lactic 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine chemistry.chemical_compound 0302 clinical medicine Lactate oxidation MESH: Bilirubin Tissue Distribution Prospective Studies MESH: Aged MESH: Middle Aged MESH: Cardiac Surgical Procedures Cardiogenic shock Middle Aged MESH: Case-Control Studies MESH: Hydrocortisone 3. Good health Lactic acid MESH: Sodium Lactate MESH: Glucose Liver Shock (circulatory) MESH: Survival Analysis MESH: Glycolysis Acidosis Lactic Female medicine.symptom Glycolysis Oxidation-Reduction Adult medicine.medical_specialty MESH: Hemodynamics Shock Cardiogenic Carbohydrate metabolism Sodium Lactate 03 medical and health sciences Internal medicine medicine Sodium lactate Humans Lactic Acid Cardiac Surgical Procedures MESH: Tissue Distribution Aged MESH: Humans business.industry Hemodynamics Bilirubin 030208 emergency & critical care medicine MESH: Adult medicine.disease Survival Analysis MESH: Shock Cardiogenic MESH: Male MESH: Prospective Studies Surgery Glucose Endocrinology chemistry Case-Control Studies Hyperglycemia Hyperlactatemia MESH: Lactic Acid business MESH: Hyperglycemia MESH: Female MESH: Liver |
| Zdroj: | Critical Care Medicine Critical Care Medicine, Lippincott, Williams & Wilkins, 2000, 28 (12), pp.3784-91 |
| ISSN: | 0090-3493 1530-0293 |
| Popis: | International audience; BACKGROUND: Hyperlactatemia is a prominent feature of cardiogenic shock. It can be attributed to increased tissue production of lactate related to dysoxia and to impaired utilization of lactate caused by liver and tissue underperfusion. The aim of this prospective observational study was to determine the relative importance of these mechanisms during cardiogenic shock. PATIENTS: Two groups of subjects were compared: seven cardiac surgery patients with postoperative cardiogenic shock and seven healthy volunteers. METHODS: Lactate metabolism was assessed by using two independent methods: a) a pharmacokinetic approach based on lactate plasma level decay after the infusion of 2.5 mmol x kg(-1) of sodium lactate; and b) an isotope dilution technique for which the transformation of [13C]lactate into [13C]glucose and 13CO2 was measured. Glucose turnover was determined using 6,62H2-glucose. RESULTS: All patients suffered from profound shock requiring high doses of inotropes and vasopressors. Mean arterial lactate amounted to 7.8 +/- 3.4 mmol x L(-1) and mean pH to 7.25 +/- 0.07. Lactate clearance was not different in the patients and controls (7.8 +/- 3.4 vs. 10.3 +/- 2.1 mL x kg(-1) x min(-1)). By contrast, lactate production was markedly enhanced in the patients (33.6 +/- 16.4 vs. 9.6 +/- 2.2 micromol x kg(-1) x min(-1); p < .01). Exogenous [13C]lactate oxidation was not different (107 +/- 37 vs. 103 +/- 4 mmol), and transformation of [13C]lactate into [13C]glucose was not different (20.0 +/- 13.7 vs. 15.2% +/- 6.0% of exogenous lactate). Endogenous glucose production was markedly increased in the patients (1.95 +/- 0.26 vs. 5.3 +/- 3.0 mg x kg(-1) x min(-1); p < .05 [10.8 +/- 1.4 vs. 29.4 +/- 16.7 micromol x kg(-1) x min(-1)]), whereas net carbohydrate oxidation was not different (1.7 +/- 0.5 vs. 1.3 +/- 0.3 mg x kg(-1) x min(-1) [9.4 +/- 2.8 vs. 7.2 +/- 1.7 micromol x kg(-1) x min(-1)]). CONCLUSIONS: Hyperlactatemia in early postoperative cardiogenic shock was mainly related to increased tissue lactate production, whereas alterations of lactate utilization played only a minor role. Patients had hyperglycemia and increased nonoxidative glucose disposal, suggesting that glucose-induced stimulation of tissue glucose uptake and glycolysis may contribute significantly to hyperlactatemia. |
| Databáze: | OpenAIRE |
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