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Leverve, Xavier; Mustafa, Iqbal

doi:10.1186/cc1509

Cited by 68 publications

(13 citation statements)

References 25 publications

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“…Lactate enters the mitochondria, where it is converted to pyruvate generating ATP, or enters the liver for gluconeogenesis. Third, glycolysis requires an initial investment of ATP before more ATP is produced [44]. Therefore, when energy stores are depleted, citrate and lactate may be preferable over glucose [36-38].…”

Section: Bioenergetic Consequencesmentioning

confidence: 99%

Bench-to-bedside review: Citrate for continuous renal replacement therapy, from science to practice

2012

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To prevent clotting in the extracorporeal circuit during continuous renal replacement therapy (CRRT) anticoagulation is required. Heparin is still the most commonly used anticoagulant. However, heparins increase the risk of bleeding, especially in critically ill patients. Evidence has accumulated that regional anticoagulation of the CRRT circuit with citrate is feasible and safe. Compared to heparin, citrate anticoagulation reduces the risk of bleeding and requirement for blood products, not only in patients with coagulopathy, but also in those without. Metabolic complications are largely prevented by the use of a strict protocol, comprehensive training and integrated citrate software. Recent studies indicate that citrate can even be used in patients with significant liver disease provided that monitoring is intensified and the dose is carefully adjusted. Since the citric acid cycle is oxygen dependent, patients at greatest risk of accumulation seem to be those with persistent lactic acidosis due to poor tissue perfusion. The use of citrate may also be associated with less inflammation due to hypocalcemia-induced suppression of intracellular signaling at the membrane and avoidance of heparin, which may have proinflammatory properties. Whether these beneficial effects increase patient survival needs to be confirmed. However, other benefits are the reason that citrate should become the first choice anticoagulant for CRRT provided that its safe use can be guaranteed.

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Section: Bioenergetic Consequencesmentioning

confidence: 99%

Bench-to-bedside review: Citrate for continuous renal replacement therapy, from science to practice

2012

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“…Lactate is metabolized by the liver (about 60 %), the kidneys (about 30 %), and other organs. Normal blood lactate concentration is around 1 mmol/L ( 2 ).One of the most important metabolic changes due to lack of oxygen is the Pasteur effect ( 3 ). Due to oxygen shortage, pyruvate derived from the anaerobic conversion of glucose cannot enter the Krebs’ cycle via acetyl-coenzyme A to produce energy ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…Normal blood lactate concentration is around 1 mmol/L ( 2 ).One of the most important metabolic changes due to lack of oxygen is the Pasteur effect ( 3 ). Due to oxygen shortage, pyruvate derived from the anaerobic conversion of glucose cannot enter the Krebs’ cycle via acetyl-coenzyme A to produce energy ( 3 ). The conversion of pyruvate to lactate allows energy production without oxygen ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

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Hyperlactatemia and the Importance of Repeated Lactate Measurements in Critically Ill Patients

Godinjak

Jusufović

Rama³

et al. 2017

Med Arch

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ObjectiveThe aim of the study was to describe the prevalence of hyperlactatemia and emphasis on repeated lactate measurements in critically ill patients, and the associated mortality.Materials and methodsThe study included 70 patients admitted in the Medical Intensive Care Unit at the Clinical Center, University of Sarajevo, in a 6-month period (July - December 2015). The following data were obtained: age, gender, reason for admission, Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation, lactate concentrations upon admission, after 24 and 48 hours, and outcome (discharge from hospital or death).ResultsUpon admission,hyperlactatemia was present in 91.4% patients with a mean concentration of lactate 4.13 ±1.21 mmol/L. Lactate concentration at 48 hours was independently associated within creased in-hospital mortality (P = 0.018).ConclusionPersistent hyperlactatemia is associated with adverse outcome in critically ill patients. Lactate concentration at 48 hours is independently associated within creased in-hospital mortality and it represents a statistically significant predictive marker of fatal outcomes of patients. Blood lactate concentrations > 2.25 mmol/L should be used by clinicians to identify patients at higher risk of death.

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“…Perhaps, in severe inflammatory states, this substitutes for the falling plasma levels of another potent circulating antioxidant, albumin, due to decreased hepatic production and increased transcapillary movement. A high blood lactate, long perceived to be deleterious due to its association with illness severity and death, is now also recognized to be potentially adaptive, offering vital organs such as the brain, heart and liver an alternative and important substrate for energy production [21,22]. Hypercapnia and hypoxemia also trigger an array of protective responses [23,24] that may be abrogated through aggressive correction.…”

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confidence: 99%

Advancing critical care: time to kiss the right frog

Singer

2013

Crit Care

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The greatest advances in critical care over the past two decades have been achieved through doing less to the patient. We have learnt through salutary experience that our burgeoning Master-of-the-Universe capabilities and the oh-so-obvious stratagems instilled in us from youth were often ineffective or even deleterious. This re-education process, however, is far from complete. We are now rightly agonizing over the need for better characterization of pathophysiology, earlier identification of disease processes and a more directed approach to therapeutic intervention. We need to delineate the point at which intrinsic and protective adaptation ends and true harmful pathology begins, and how our iatrogenic meddling either helps or hinders. We need to improve trial design in the heterogeneous populations we treat, and to move away from syndromic fixations that, while offering convenience, have generally proved counterproductive. Importantly, we need to discover a far more holistic approach to patient care, evolving from the prevailing overmedicalized, number-crunching perspective towards a true multidisciplinary effort that embraces psychological as well as physiological well-being, with appropriate pharmacological minimization or supplementation. Complacency, with an unfair apportion of blame on the patient for not getting better, is the biggest threat to continued improvement.

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Untitled

Cited by 68 publications

References 25 publications

Bench-to-bedside review: Citrate for continuous renal replacement therapy, from science to practice

Bench-to-bedside review: Citrate for continuous renal replacement therapy, from science to practice

Hyperlactatemia and the Importance of Repeated Lactate Measurements in Critically Ill Patients

Advancing critical care: time to kiss the right frog

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