Gastric PgCO2 and Pg-aCO2 gap are related to D-lactate and not to L-lactate levels in patients with septic shock.
OBJECTIVE
Intestinal ischemia causes an increase in lactate production and gastric intramucosal carbon dioxide partial pressure (PgCO(2)). However, no linear relationship between systemic l-lactate levels and gastric tonometry during intestinal ischemia has been found, probably since l-lactate is rapidly cleared from the circulation by the liver. In contrast, the rate of d-lactate clearance from the circulation by the liver is considerably lower than that of l-lactate, and d-lactate may therefore be more closely related to measurements of gastric tonometry than l-lactate values.


METHODS
Prospective, observational study in a university-affiliated mixed intensive care unit.


METHODS
Twenty critically ill patients with septic shock.


RESULTS
During the first 24 h of admission to the intensive care unit at least two blood samples were taken for d- and l-lactate measurements and arterial blood gases, Simultaneously, gastric PgCO(2) was measured using capnographic tonometry. The intramucosal-arterial PCO(2) gap was calculated using gastric intramucosal PgCO(2) and arterial PCO(2) from arterial blood. d-Lactate was significantly correlated to PgCO(2) values and to the mucosal-arterial PCO(2) gap. There was no relationship between l-lactate and PgCO(2) or the mucosal-arterial PCO(2) gap. d-lactate and l-lactate values were significantly correlated.


CONCLUSIONS
During sepsis intestinal production of d-lactate is related to gastric intramucosal PCO(2). No such relationship was found between l-lactate values and PgCO(2)
Poeze
Martijn
M
Department of Surgery and Intensive Care Medicine, University Hospital Maastricht, Maastricht, The Netherlands. m_poeze@hotmail.com
Solberg
Barbara C J
BC
Greve
Jan Willem M
JW
Ramsay
Graham
G
D000136:Acid-Base Equilibrium; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000032:analysis / Q000378:metabolism*; D016638:Critical Illness; D005753:Gastric Mucosa / Q000098:blood supply / Q000378:metabolism; D006801:Humans; D007422:Intestines / Q000098:blood supply; D007511:Ischemia / Q000378:metabolism* / Q000382:microbiology; D007536:Isomerism; D019344:Lactic Acid / Q000097:blood*; D016014:Linear Models; D008657:Metabolic Clearance Rate; D015999:Multivariate Analysis; D010313:Partial Pressure; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012772:Shock, Septic / Q000150:complications / Q000378:metabolism* / Q000401:mortality; D013152:Splanchnic Circulation; D016019:Survival Analysis
D015415:Biomarkers; D002245:Carbon Dioxide; D019344:Lactic Acid