Effect of bicarbonate and lactate buffer on glucose and lactate metabolism during hemodiafiltration in patients with multiple organ failure.
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.
Bollmann
Marc-Daniel
MD
Surgical Intensive Care Unit, University Hospital CHUV, 1011 Lausanne, Switzerland.
Revelly
Jean-Pierre
JP
Tappy
Luc
L
Berger
Mette M
MM
Schaller
Marie-Denise
MD
Cayeux
Marie-Christine
MC
Martinez
Alexandre
A
Chioléro
René-Louis
RL
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
D001786:Blood Glucose; D002021:Buffers; D019344:Lactic Acid; D017693:Sodium Bicarbonate