X-Message-Number: 27240 Date: Wed, 19 Oct 2005 12:50:26 +0200 From: Eugen Leitl <> Subject: [: [ccm-l] Lactate as a marker of energy failure in critically ill patients] ----- Forwarded message from Eric Hodgson <> ----- From: Eric Hodgson <> Date: Wed, 19 Oct 2005 12:46:16 +0200 To: Subject: [ccm-l] Lactate as a marker of energy failure in critically ill patients X-mailer: Pegasus Mail for Windows (4.21c) Reply-To: Lactate as a marker of energy failure in critically ill patients: hypothesis Franco Valenza , Gabriele Aletti , Tommaso Fossali , Giorgio Chevallard , Francesca Sacconi , Manuela Irace and Luciano Gattinoni Istituto di Anestesia e Rianimazione, Universit? degli Studi di Milano, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena ? Fondazione IRCCS di Natura Pubblica, Milan, Italy Critical Care 2005, in press doi:10.1186/cc3818 Published 28 September 2005 Abstract Lactate measurement in the critically ill has been traditionally used to stratify patients with poor outcome. However, plasma lactate levels are the result of a finely tuned interplay of factors that affect the balance between its production and its clearance. When the oxygen supply does not match its consumption, organisms such as man who are forced to produce ATP for their integrity adapt in many different ways up to the point when energy failure occurs. Lactate, being part of the adaptive response, may then be used to assess the severity of the supply/demand imbalance. In such a scenario, the time to intervention becomes relevant: early and effective treatment may allow the cell to revert to a normal state, as long as the oxygen machinery (i.e. mithocondria) is intact. Conversely, once the mithocondria are deranged, energy failure occurs even in the presence of normoxia. The lactate increase in critically ill patients may therefore be viewed as an early marker of a potentially reversible state. ----- End forwarded message ----- -- Eugen* Leitl <a href="http://leitl.org">leitl</a> ______________________________________________________________ ICBM: 48.07100, 11.36820 http://www.leitl.org 8B29F6BE: 099D 78BA 2FD3 B014 B08A 7779 75B0 2443 8B29 F6BE Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=27240