title: d-lactate as a marker of venous-induced intestinal ischemia: an experimental study in pigs.
abstract: BACKGROUND
  Intestinal ischemia is difficult to diagnose. The search for biomarkers has led to an increased interest in d-lactate. d-lactate measured in higher concentrations arises from bacterial fermentation in the gastrointestinal tract. Permeable intestinal wall is an early consequence of intestinal ischemia, which allows d-lactate to enter the portal circulation.
  
  
  METHODS
  The superior mesenteric vein was clamped in eight pigs for two hours to induce ischemia of the intestine. Eight sham-operated pigs served as controls. Systemic and portal plasma d- and l-lactate, l-LDH and leukocytes were measured.
  
  
  RESULTS
  Plasma d-lactate increased significantly and nearly simultaneously in the systemic and portal circulation. After 75 min, samples from the jugular vein showed concentrations of .019 ± .008 mmol/L in the sham group and .042 ± .022 mmol/L in the intervention group (P = .023). A similar significant effect was seen in the portal circulation after 90 min. l-lactate increased five minutes after clamping in the portal circulation, with values of 3.396 ± 1.119 mmol/L in the intervention group compared to 1.696 ± .483 mmol/L in the control group (P = .006). l-LDH increased significantly in the intervention group, while leukocytes were unaffected. l-LDH and l-lactate in plasma led to an overestimation of d-lactate if not handled.
  
  
  CONCLUSIONS
  Both systemic d- and l-lactate were markers of venous-induced intestinal ischemia. We speculate that d-lactate may be a valuable aid to the clinician in search of the anaerobic focus, because it may be more specific for mesenteric ischemia than l-lactate, in the sense that it is of bacterial origin.
authors.affiliation: Vascular Research Unit, Viborg Regional Hospital, Heibergs Allé 4, DK-8800 Viborg, Denmark. casper.dr@gmail.com
authors.forename: Casper
authors.initials: C
authors.lastname: Nielsen
authors.forename: Jes S
authors.initials: JS
authors.lastname: Lindholt
authors.forename: Erland J
authors.initials: EJ
authors.lastname: Erlandsen
authors.forename: Frank V
authors.initials: FV
authors.lastname: Mortensen
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D005260:Female; D007422:Intestines / Q000098:blood supply* / Q000473:pathology; D007511:Ischemia / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D007770:L-Lactate Dehydrogenase / Q000097:blood; D019344:Lactic Acid / Q000097:blood*; D007958:Leukocyte Count; D008642:Mesenteric Veins; D011897:Random Allocation; D013552:Swine
chemical_list: D015415:Biomarkers; D019344:Lactic Acid; D007770:L-Lactate Dehydrogenase