Effect of bicarbonate and lactate buffer on glucose and lactate metabolism during hemodiafiltration in patients with multiple organ failure
Effect of bicarbonate and lactate buffer on glucose and lactate metabolism during hemodiafiltration in patients with multiple organ failure
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DOI：
10.1007/s00134-004-2251-3
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发表时间：
2004-06-01
影响因子：
38.9
通讯作者：
Chioléro, RL
中科院分区：
文献类型：
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作者：
Bollmann, MD;Revelly, JP;Chioléro, RL
Objective.比较碳酸氢钠和乳酸盐用于危重患者连续性静脉-静脉血液透析滤过（CVVHDF）的效果。设计和设置。一项在大学医院外科和内科ICU中进行的前瞻性交叉对照试验。患者8例需要CVVHDF的多器官功能障碍综合征（MODS）患者。干预每名患者在连续两天内以随机顺序接受两种缓冲液。测量和结果。测定以下变量：酸碱参数、乳酸盐产生和利用（C-13乳酸盐输注）、葡萄糖周转（6，6（2）H（2）-葡萄糖）、气体交换（间接量热法）。乳酸盐给药期间未观察到副作用。两种缓冲液的基线动脉酸碱变量相等。在乳酸盐期间，动脉乳酸盐（2.9与1.5 mmol/l）、葡萄糖代谢率（+18%）和葡萄糖代谢率（+23%）较高。CVVHDF中的碳酸氢盐和葡萄糖损失很大，但乳酸盐未消除。输注C-13乳酸盐增加血浆乳酸盐水平与两种缓冲液相同。乳酸清除率（碳酸氢盐和乳酸阶段分别为7.8+/-0.8 vs 7.5+/-0.8 ml/kg/min）和内源性生成率（14.0+/-2.6 vs 13.6+/-2.6 mmol/kg/min）相似。C-13乳酸盐用作代谢底物，如（CO2）-C-13排泄所示。在乳酸盐输注期间，血糖和代谢率在两个阶段显著增加，并且相似。结论在不需要CVVHDF的急性肝衰竭的危重患者中，乳酸盐被迅速从血液中清除，转化为葡萄糖或氧化。除中度高血糖外，乳酸盐未产生不良影响，对酸碱平衡的影响与碳酸氢盐相当。
Objective. To compare the effects of sodium bicarbonate and lactate for continuous veno-venous hemodiafiltration (CVVHDF) in critically ill patients. Design and settings. Prospective crossed-over controlled trial in the surgical and medical ICUs of a university hospital. Patients. Eight patients with multiple organ dysfunction syndrome (MODS) requiring CVVHDF. Intervention. Each patient received the two buffers in a randomized sequence over two consecutive days. Measurements and results. The following variables were determined: acid-base parameters, lactate production and utilization (C-13 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 C-13 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. C-13 lactate was used as a metabolic substrate, as shown by (CO2)-C-13 excretion. Glycemia and metabolic rate increased significantly and similarly during the two periods during lactate infusion. Conclusion. 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.