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Transvisceral lactate fluxes during early endotoxemia

Bellomo, R and Kellum, JA and Pinsky, MR (1996) Transvisceral lactate fluxes during early endotoxemia. Chest, 110 (1). 198 - 204. ISSN 0012-3692

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Abstract

The pathogenesis of hyperlacticemia during sepsis is poorly understood. We investigated the role of lung, kidney, gut, liver, and muscle in endogenous lactate uptake and release during early endotoxemia in an intact, pentobarbital-anesthetized dog model (n=14). Ultrasonic flow probes were placed around the portal vein and hepatic, renal, and femoral arteries. After splenectomy, catheters were inserted into the pulmonary artery, aorta, and hepatic, left renal, and femoral veins. Whole blood lactate and blood gases from all catheters, organ flows, and cardiac output were measured before and 30 to 45 min after a bolus infusion of Escherichia coli endotoxin (1 mg/kg). After endotoxin infusion, mean arterial blood lactate level increased from 0.92±0.11 to 1.60±0.15 mmol/L (p<0.0001). Lung lactate flux changed from uptake to release of lactate adding a mean of 9.97±16.23 mmol/h (p<0.05) to the systemic circulation. Liver and muscle lactate fluxes remained neutral at all times, while kidney and gut took up lactate from the circulation both before and after endotoxin infusion (mean renal uptake, 2.73±3.85 mmol/L; p<0.001; mean gut uptake, 2.46±2.31 mmol/h; p<0.002). Except for the kidney, where a decrease in blood flow correlated with diminished uptake, there was no correlation between changes in transvisceral lactate fluxes and organ or systemic oxygen delivery during endotoxemia. A positive correlation between lactate uptake and oxygen consumption during endotoxemia was seen for both gut (p<0.0001) and kidney (p<0.002). We conclude that, in the dog, the pathogenesis of endotoxin-induced hyperlacticemia is complex. The lung may be responsible for significant lactate release, and other viscera that normally take up lactate are unable to adequately clear this increased lactate.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Bellomo, R
Kellum, JAkellum@pitt.eduKELLUM0000-0003-1995-2653
Pinsky, MRpinsky@pitt.eduPINSKY
Date: 1 January 1996
Date Type: Publication
Journal or Publication Title: Chest
Volume: 110
Number: 1
Page Range: 198 - 204
DOI or Unique Handle: 10.1378/chest.110.1.198
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0012-3692
Related URLs:
PubMed ID: 8681628
Date Deposited: 05 Mar 2012 19:55
Last Modified: 04 Feb 2019 15:56
URI: http://d-scholarship.pitt.edu/id/eprint/11236

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