Cerebrospinal Fluid Glucose and Lactate: Age-Specific Reference Values and Implications for Clinical Practice

Abstract

Cerebrospinal fluid (CSF) analysis is an important tool in the diagnostic work-up of many neurological disorders, but reference ranges for CSF glucose, CSF/plasma glucose ratio and CSF lactate based on studies with large numbers of CSF samples are not available. Our aim was to define age-specific reference values. In 1993 The Nijmegen Observational CSF Study was started. Results of all CSF samples that were analyzed between 1993 and 2008 at our laboratory were systematically collected and stored in our computerized database. After exclusion of CSF samples with an unknown or elevated erythrocyte count, an elevated leucocyte count, elevated concentrations of bilirubin, free hemoglobin, or total protein 9,036 CSF samples were further studied for CSF glucose (n = 8,871), CSF/plasma glucose ratio (n = 4,516) and CSF lactate values (n = 7,614). CSF glucose, CSF/plasma glucose ratio and CSF lactate were age-, but not sex dependent. Age-specific reference ranges were defined as 5–95th percentile ranges. CSF glucose 5th percentile values ranged from 1.8 to 2.9 mmol/L and 95th percentile values from 3.8 to 5.6 mmol/L. CSF/plasma glucose ratio 5th percentile values ranged from 0.41 to 0.53 and 95th percentile values from 0.82 to 1.19. CSF lactate 5th percentile values ranged from 0.88 to 1.41 mmol/L and 95th percentile values from 2.00 to 2.71 mmol/L. Reference ranges for all three parameters were widest in neonates and narrowest in toddlers, with lower and upper limits increasing with age. These reference values allow a reliable interpretation of CSF results in everyday clinical practice. Furthermore, hypoglycemia was associated with an increased CSF/plasma glucose ratio, whereas hyperglycemia did not affect the CSF/plasma glucose ratio.

Magnetic resonance spectroscopy reveals abnormalities of glucose metabolism in the Alzheimer's brain

“…For example, glucose is detectable in the CSF at over three times its concentration in GM or WM 28, 29, 30. This is also the case for lactate, which is detectable in CSF but negligible in normal brain tissue 26.…”

Child Neurology: Differential diagnosis of a low CSF glucose in children and young adults

“…Little is known, however, about the differential diagnosis of a low CSF glucose in the absence of an elevated cell count or elevated CSF lactate level (further referred to as "isolated low CSF glucose"). Therefore, we additionally performed a retrospective search in our CSF database 3 for CSF samples of patients younger than 21 years of age with an isolated low CSF glucose (figure 1). Between 1993 and2008, the results of all CSF samples that were analyzed at the laboratory of our tertiary referral hospital (the Radboud University Medical Centre in Nijmegen, the Netherlands) were systematically collected.…”

“…Between 1993 and2008, the results of all CSF samples that were analyzed at the laboratory of our tertiary referral hospital (the Radboud University Medical Centre in Nijmegen, the Netherlands) were systematically collected. 3 Out of 10,193 CSF samples of patients younger than 21 years of age, we identified 68 samples (0.7%) of 64 unique patients with an isolated low CSF glucose (for inclusion and exclusion criteria see figure e-1 on the Neurology ® Web site at www.neurology.org). For methods, we refer to Leen et al 3 Medical records of these patients were evaluated (according to the regulations of the local Medical Ethical Committee, METC Arnhem-Nijmegen) (table e-1).…”

“…3 Out of 10,193 CSF samples of patients younger than 21 years of age, we identified 68 samples (0.7%) of 64 unique patients with an isolated low CSF glucose (for inclusion and exclusion criteria see figure e-1 on the Neurology ® Web site at www.neurology.org). For methods, we refer to Leen et al 3 Medical records of these patients were evaluated (according to the regulations of the local Medical Ethical Committee, METC Arnhem-Nijmegen) (table e-1). Two patients were already diagnosed with GLUT1DS.…”

Transient Unilateral Lower Limb Palsy after Open Surgery Thoraco-Abdominal Aorta Repair

“…During the operation we monitored intratecal pressure (P csf ) and the spinal cord perfusion pressure (PP csf ) along with Lactate concentration into CSF (Lac csf ) because it may be a marker of local ischemic suffering [5][6][7][8]. Lac csf and P csf did not showed significant alterations, intraoperatively.…”