Influence of glucose kinetics on plasma lactate concentration and energy expenditure in severely burned patients

D. C. Gore, A. Ferrando, J. Barnett, S. E. Wolf, M. Desai, D. N. Herndon, C. Goodwin, R. R. Wolfe, J. W. Davis, J. H. Siegel, F. Luchette, R. J. Mullins, D. C. Gore

    Research output: Contribution to journalArticle

    34 Scopus citations

    Abstract

    Background: In critically ill patients, elevation in the plasma lactate concentration has traditionally been interpreted as indicating a deficiency in oxygen availability and is often an impetus to increase oxygen delivery clinically. However, another possible basis for increased lactate concentrations may be simply a mass effect from increased pyruvate availability (i.e., accelerated glycolysis). Methods: In six hypermetabolic burned patients, the rates of glucose production and oxidation were quantified using a tracer infusion of 6,6 d2 glucose combined with indirect calorimetry. Measurements were obtained after a 9-hour fast and after a 3-hour infusion of unlabeled glucose at 30 μmol/kg/min. No patient was overtly septic, hypoxic, or hypovolemic. Results: The infusion of glucose significantly increased the arterial glucose concentration and rate of glucose oxidation, with a corresponding increase in the arterial plasma concentration of lactate and pyruvate. Resting energy expenditure and oxygen consumption were not affected by the infusion of glucose. Conclusions: These findings show that elevations in plasma lactate in severely injured patients may, in part, be related to increases in glucose flux and not entirely a reflection of any deficit in oxygen availability. Such findings highlight a potential pitfall for interpreting plasma lactate concentrations as an index of tissue oxygen availability in hypermetabolic patients.

    Original languageEnglish (US)
    Pages (from-to)673-678
    Number of pages6
    JournalJournal of Trauma - Injury, Infection and Critical Care
    Volume49
    Issue number4
    DOIs
    StatePublished - Jan 1 2000

    Keywords

    • Hypermetabolism
    • Oxygen availability
    • Pyruvate

    ASJC Scopus subject areas

    • Surgery
    • Critical Care and Intensive Care Medicine

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    Gore, D. C., Ferrando, A., Barnett, J., Wolf, S. E., Desai, M., Herndon, D. N., Goodwin, C., Wolfe, R. R., Davis, J. W., Siegel, J. H., Luchette, F., Mullins, R. J., & Gore, D. C. (2000). Influence of glucose kinetics on plasma lactate concentration and energy expenditure in severely burned patients. Journal of Trauma - Injury, Infection and Critical Care, 49(4), 673-678. https://doi.org/10.1097/00005373-200010000-00015