EDITORIALI   Free

Minerva Anestesiologica 1999 May;65(5):205-9

Copyright © 1999 EDIZIONI MINERVA MEDICA

lingua: Inglese

Lactic acidosis. A new insight?

Leverve X. M.

Laboratoire de Bioénergétique, Fondamentale et Appliquée, Université Joseph Fourier and Service de Réanimation Médicale, Hôpital A. Michallon, Centre Hospitalier Universitaire Grenoble, France

From an inten­si­vist ­point of ­view, lac­tic ­acid is (i) respon­sible for meta­bol­ic aci­do­sis, (ii) relat­ed to anox­ia or ische­mia and (iii) asso­ciat­ed ­with ­poor prog­no­sis. Conversely, ­from a bio­chem­ist ­point of ­view lac­tate is a ­good cel­lu­lar sub­strate ­which can be eas­i­ly con­vert­ed to pyru­vate and ­used as glu­co­ne­o­gen­ic sub­strate, or oxid­ised or trans­am­i­nat­ed ­into ala­nine. Hence the ­main ques­tion is not any­more to ­assess the val­ue of lac­tate con­cen­tra­tion as a mark­er of sever­ity (it is ­well estab­lished) but rath­er to under­stand the meta­bol­ic mean­ing of its ­increase: is it ben­e­fi­cial or del­e­ter­i­ous? In ­fact sev­er­al ­recent experi­men­tal ­works ­have ­shown ­that ­instead of ­being a neg­a­tive con­se­quence, lac­tate pro­duc­tion and relat­ed meta­bol­ic aci­do­sis due to the stim­u­la­tion of anaer­o­bic ATP-pro­duc­tion path­way ­could be a pro­tec­tive adapt­ed ­response.