title: Effect of bicarbonate and lactate buffer on glucose and lactate metabolism during hemodiafiltration in patients with multiple organ failure.
abstract: OBJECTIVE
  To compare the effects of sodium bicarbonate and lactate for continuous veno-venous hemodiafiltration (CVVHDF) in critically ill patients.
  
  
  METHODS
  Prospective crossed-over controlled trial in the surgical and medical ICUs of a university hospital.
  
  
  METHODS
  Eight patients with multiple organ dysfunction syndrome (MODS) requiring CVVHDF.
  
  
  METHODS
  Each patient received the two buffers in a randomized sequence over two consecutive days.
  
  
  RESULTS
  The following variables were determined: acid-base parameters, lactate production and utilization ((13)C lactate infusion), glucose turnover (6,6(2)H(2)-glucose), gas exchange (indirect calorimetry). No side effect was observed during lactate administration. Baseline arterial acid-base variables were equal with the two buffers. Arterial lactate (2.9 versus 1.5 mmol/l), glycemia (+18%) and glucose turnover (+23%) were higher in the lactate period. Bicarbonate and glucose losses in CVVHDF were substantial, but not lactate elimination. Infusing (13)C lactate increased plasma lactate levels equally with the two buffers. Lactate clearance (7.8+/-0.8 vs 7.5+/-0.8 ml/kg per min in the bicarbonate and lactate periods) and endogenous production rates (14.0+/-2.6 vs 13.6+/-2.6 mmol/kg per min) were similar. (13)C lactate was used as a metabolic substrate, as shown by (13)CO(2) excretion. Glycemia and metabolic rate increased significantly and similarly during the two periods during lactate infusion.
  
  
  CONCLUSIONS
  Lactate was rapidly cleared from the blood of critically ill patients without acute liver failure requiring CVVHDF, being transformed into glucose or oxidized. Lactate did not exert undesirable effects, except moderate hyperglycemia, and achieved comparable effects on acid-base balance to bicarbonate.
authors.affiliation: Surgical Intensive Care Unit, University Hospital CHUV, 1011 Lausanne, Switzerland.
authors.forename: Marc-Daniel
authors.initials: MD
authors.lastname: Bollmann
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Revelly
authors.forename: Luc
authors.initials: L
authors.lastname: Tappy
authors.forename: Mette M
authors.initials: MM
authors.lastname: Berger
authors.forename: Marie-Denise
authors.initials: MD
authors.lastname: Schaller
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Cayeux
authors.forename: Alexandre
authors.initials: A
authors.lastname: Martinez
authors.forename: René-Louis
authors.initials: RL
authors.lastname: Chioléro
mesh_terms: D000136:Acid-Base Equilibrium / Q000187:drug effects; D000368:Aged; D000704:Analysis of Variance; D001786:Blood Glucose / Q000187:drug effects; D002021:Buffers; D018592:Cross-Over Studies; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D019344:Lactic Acid / Q000097:blood / Q000493:pharmacokinetics / Q000494:pharmacology*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000628:therapy*; D011446:Prospective Studies; D017693:Sodium Bicarbonate / Q000493:pharmacokinetics / Q000494:pharmacology*; D014882:Water-Electrolyte Balance / Q000187:drug effects
chemical_list: D001786:Blood Glucose; D002021:Buffers; D019344:Lactic Acid; D017693:Sodium Bicarbonate