Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Lactate Metabolism During Marginal Liver Perfusion

Lactate Metabolism During Marginal Liver Perfusion Abstract Huckabee has shown that during shock and hypotension there is an accumulation of excess lactate.1 In previous studies, we2,3 have shown that lactated Ringer's solution is effective in the resuscitation from hemorrhagic shock in both the experimental animal and in man, and does not result in accumulation of the exogenous lactate load. Lactate is converted to pyruvate mainly in the liver,4 but small amounts are metabolized by the kidney5 and myocardium.6 Although these studies demonstrate that during marked hypotension there is essentially normal metabolism of lactate, there inevitably must be a minimal point of liver perfusion at which lactate is no longer converted to pyruvate. The purpose of this study is to determine the minimal liver blood flow at which exogenous lactate no longer is metabolized. Materials and Methods Variable Rates of Hepatic Artery and Portal Venous Flow (Part 1).—Utilizing an isolated pig References 1. Huckabee, W.E.: Relationships of Pyruvate and Lactate During Anaerobic Metabolism: I. Effects of Infusion of Pyruvate or Glucose and of Hyperventilation , J Clin Invest 37:244-254 ( (Feb) ) 1958.Crossref 2. Trinkle, J.K.; Rush, B.F.; and Eiseman, B.: Lactate Metabolism Following Hemorrhage , Surg Forum 18:1-21, 1967. 3. Rush, B., and Eiseman, B.: Limits of Non-Colloid Solution Replacement in Experimental Hemorrhagic Shock , Ann Surg 165:977-984 ( (June) ) 1967.Crossref 4. Cori, C.F., and Cori, G.T.: Glycogen Formation in the Liver From D- and L-Lactic Acid , J Biol Chem 81:389-403 (Feb) 1929. 5. Levy, M.N.: Uptake of Lactate and Pyruvate by Intact Kidney of the Dog , Amer J Physiol 202:302-308 ( (Feb) ) 1962. 6. Evans, C.L., et al: The Utilization of Blood Sugar and Lactate by the Heart-Lung Preparation , J Physiol 80:21-40 ( (Nov) ) 1934. 7. Eiseman, B., et al: Isolated Liver Perfusion for Reducing Blood Ammonia , Arch Surg 83:356-363 ( (Sept) ) 1961.Crossref 8. Olson, G.F.: Optimal Conditions for the Enzymatic Determination of L-Lactic Acid , Clin Chem 8:1-10 ( (Feb) ) 1962. 9. Tait, I.B., and Eiseman, B.: Perfusion Dynamics for Extracorporeal Hepatic Assist , Arch Surg 93:131-141 ( (July) ) 1966.Crossref 10. Mahler, H.R., and Cordes, E.H.: Biological Chemistry , New York: Harper & Row Publishers, Inc., 1966, p 411. 11. McShan, W.H., et al: Biological Energy Transformations During Shock as Shown by Blood Chemistry , Amer J Physiol 145:93-106 ( (Nov) ) 1945. 12. Shubin, H., and Weil, M.H.: Acute Elevation of Serum Transaminase and Lactic Dehydrogenase During Circulatory Shock , Amer J Cardiol 11:327-331 ( (March) ) 1963.Crossref 13. Alpert, N.R.: Lactate Production and Removal and the Regulation of Metabolism , Ann NY Acad Sci 119:995-1012 ( (July 31) ) 1965.Crossref 14. Harris, P.; Bateman, M.; and Gloster, J.: Relations Between the Cardio-Respiratory Effects of Exercise and the Arterial Concentration of Lactate and Pyruvate in Patients with Rheumatic Heart Disease , Clin Sci 23:531 ( (March) ) 1962. 15. Olson, R.E.: "Excess Lactate" and Anaerobiosis , Ann Intern Med 59:960-963 ( (Dec) ) 1963.Crossref 16. LePage, G.A.: Biological Energy Transformations During Shock as Shown by Tissue Analyses , Amer J Physiol 146:267-281 ( (May) ) 1946. 17. Kovach, A.G.B., and Fonyo, A.: The Biochemical Response to Injury , H. B. Stomer (ed.), Springfield, Ill: Charles C Thomas, Publisher 1960, p 145. 18. Dahl, N.A., and Balfour, W.M.: Prolonged Anoxic Survival due to Preexposure to Anoxia: Brain ATP and Lactate Changes , Fed Proc 22:2823 ( (March) -April) 1963. 19. Swenson, O., et al: Immediate and Long-Term Effects of Acute Hepatic Ischemia , Arch Surg 95:451-463 ( (Sept) ) 1967.Crossref 20. Talaat, S.M.; Massion, W.H.; and Schilling, J.A.: Effects of ATP Administration in Irreversible Hemorrhagic Shock , Surgery 55:813-819 ( (June) ) 1964. 21. Sharma, G.P., and Eiseman, B.: Protective Effect of ATP in Experimental Hemorrhagic Shock , Surgery 59:66-75 ( (Jan) ) 1966. 22. Huckabee, W.E.: Abnormal Resting Blood Lactate: II. Lactic Acidosis , Amer J Med 30:840-848 ( (June) ) 1961.Crossref 23. Tianquada, R.E.; Grant, W.J.; and Peterson, C.R.: Lactic Acidosis , Arch Intern Med 117:192-202 ( (Feb) ) 1966.Crossref 24. Hartmann, A.F., and Senn, M.J.E.: Studies in the Metabolism of Sodium r-Lactate: I. Response of Normal Human Subjects to the Intravenous Injection of Sodium r-Lactate , J Clin Invest 11:327-335 ( (March) ) 1932.Crossref 25. Wasserman, K., Burton, G.G., and Von Kessel, A.L.: Excess Lactate Concept and Oxygen Debt of Exercise , J Appl Physiol 20:1299-1306 ( (Nov) ) 1961. 26. Collins, J.A.: Some Observations on Acid-Base Balance in Combat Casualties, section G, Surgical Research Team, Vietnam, Walter Reed Army Institute of Research (Jan 9) 1967. 27. Laug, E.P.: Observations on Lactic Acid, Total CO2, and pH of Venous Blood During Recovery From Severe Exercise , Amer J Physiol 107:687-692 ( (March) ) 1934. 28. Bruce, R.A.; Jones, J.W.; and Strait, G.B.: Anaerobic Metabolic Responses to Acute Maximal Exercise in Male Athletes Amer Heart J 67:643-650 ( (May) ) 1964.Crossref 29. Marshall, R.J., and Darby, T.D.: Shock: Pharmacological Principles in Treatment , Springfield, Ill: Charles C Thomas, Publisher, 1966, p 10. 30. Pitts, F.N., and McClure, J.N.: Lactate Metabolism in Anxiety Neurosis , New Eng J Med 277:1329-1336 ( (Dec 21) ) 1967. 31. Goldblatt, M.W.: Ergotamine and the Effect of Adrenalin on Blood Lactate , J Physiol 78:96-105 ( (April) ) 1933. 32. Newman, E.V., et al: The Rate of Lactic Acid Removal in Exercise , Amer J Physiol 118:457-462 ( (March) ) 1937. 33. Drury, D.R., and Wick, A.N.: Chemistry and Metabolism of L (+) and D (−) Lactic Acids , Ann NY Acad Sci 119:1061-1069 ( (July 31) ) 1965.Crossref 34. Dunlop, R.H., and Hammond, P.B.: D-Lactic Acidosis of Ruminants , Ann NY Acad Sci 119:1109-1132 ( (July 31) ) 1965.Crossref 35. Alpert, N.R., and Root, W.S.: Relationship Between Excess Respiratory Metabolism and Utilization of Intravenously Infused Sodium Racemic Lactate and Sodium L (-) Lactate , Amer J Physiol 177:455-462 ( (June) ) 1954. 36. Margaria, R., and Edwards, H.T.: The Removal of Lactic Acid From the Body During Recovery From Muscular Exercise , Amer J Physiol 107:681-686 ( (March) ) 1934. 37. Brin, M.: The Synthesis and Metabolism of Lactic Acid Isomers , Ann NY Acad Sci 119:942-956 ( (July 31) ) 1965.Crossref 38. Rosenburg, J.C., and Rush, B.F.: An Enzymatic-Spectrophotometric Determination of Pyruvic and Lactic Acid in Blood , Clin Chem 12:299-307 ( (May) ) 1966. 39. Lockwood, L.B.; Yoder, D.E.; and Zienty, M.: Lactic Acid , Ann NY Acad Sci 119:854-867 ( (July 31) ) 1965.Crossref 40. Trudnowski, R.J.: Hydration With Ringer's Lactate Solution , JAMA 195:545-548 ( (Feb 14) ) 1966.Crossref 41. Fogelman, M.J., and Wilson, B.J.: A Different Concept of Volume Replacement in Traumatic Hypovolemia , Amer J Surg 99:694-701 ( (May) ) 1960.Crossref 42. Dillon, J., et al: The Treatment of Hemorrhagic Shock , Surg Gynec Obstet 122:967-978 ( (May) ) 1966. 43. Baue, A.E., et al: Hemodynamic and Metabolic Effects of Ringer's Lactate Solution in Hemorrhagic Shock , Ann Surg 166:29-38 ( (July) ) 1967.Crossref 44. Hartmann, A.F., and Senn, J.E.: Studies in Metabolism of Sodium r-Lactate: II. Response of Human Subjects With Acidosis to the Intravenous Injection of Sodium 4-Lactate , J Clin Invest 11:337-344 (March) 1932.Crossref 45. Hoffman, W.S.: The Biochemistry of Clinical Medicine , ed 3, Chicago: Year Book Medical Publishers, Inc. 1964, p 228. 46. Moore, D., and Bernhard, W.F.: Efficacy of Tris Buffer in the Management of Metabolic Lacticacidosis Accompanying Prolonged Hypothermie Perfusions , Surgery 52:905-912 ( (Dec) ) 1962. 47. Bunker, J.P., et al: Citric Acid Intoxication , JAMA 157:1361-1367 ( (April 16) ) 1955.Crossref 48. Bunker, J.P.; Bendixon, H.H.; and Murphy, A.J.: Hemodynamic Effects of Intravenously Administered Sodium Citrate , New Eng J Med 266:372-377 ( (Feb 22) ) 1962.Crossref 49. Howland, W.S., et al: Massive Blood Replacement: V. Failure to Observe Citrate Intoxication , Surg Gynec Obstet 105:529-540 ( (Nov) ) 1957. 50. Torrance, H.B.: The Control of the Hepatic Arterial Circulation , J Physiol 158:39-49 ( (Sept) ) 1961. 51. Schimassek, H.: Lactate Metabolism in the Isolated Perfused Rat Liver , Ann NY Acad Sci 119:1013-1028 ( (July 31) ) 1965.Crossref 52. Vang, J.O., and Drapanas, T.: Metabolism of Lactic Acid and Keto Acids by the Isolated Perfused Calf Liver , Ann Surg 163:545-552 ( (April) ) 1966.Crossref 53. Fine, J.: " The Liver in Traumatic Shock ," in Brauer, R.W. (ed.): Liver Function , Washington, DC: American Institute of Biological Sciences, 1958, p 586. 54. Schimassek, H: Perfusion of Isolated Rat Liver With a Semisynthetic Medium and Control of Liver Function , Life Sci 2:629-634 ( (Sept) ) 1962.Crossref 55. Ballinger, W.F.; Vollenweider, H.; and Montgomery, E.H.: The Response of the Canine Liver to Anaerobic Metabolism Induced by Hemorrhagic Shock , Surg Gynec Obstet 112:19-26 ( (Jan) ) 1961. 56. Eldridge, F.: Blood Lactate and Pyruvate in Pulmonary Insufficiency , New Eng J Med 274:878-883 ( (April 21) ) 1966.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Lactate Metabolism During Marginal Liver Perfusion

Loading next page...
 
/lp/american-medical-association/lactate-metabolism-during-marginal-liver-perfusion-Tjzwv0G6Vb

References (62)

Publisher
American Medical Association
Copyright
Copyright © 1969 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1969.01340130077014
Publisher site
See Article on Publisher Site

Abstract

Abstract Huckabee has shown that during shock and hypotension there is an accumulation of excess lactate.1 In previous studies, we2,3 have shown that lactated Ringer's solution is effective in the resuscitation from hemorrhagic shock in both the experimental animal and in man, and does not result in accumulation of the exogenous lactate load. Lactate is converted to pyruvate mainly in the liver,4 but small amounts are metabolized by the kidney5 and myocardium.6 Although these studies demonstrate that during marked hypotension there is essentially normal metabolism of lactate, there inevitably must be a minimal point of liver perfusion at which lactate is no longer converted to pyruvate. The purpose of this study is to determine the minimal liver blood flow at which exogenous lactate no longer is metabolized. Materials and Methods Variable Rates of Hepatic Artery and Portal Venous Flow (Part 1).—Utilizing an isolated pig References 1. Huckabee, W.E.: Relationships of Pyruvate and Lactate During Anaerobic Metabolism: I. Effects of Infusion of Pyruvate or Glucose and of Hyperventilation , J Clin Invest 37:244-254 ( (Feb) ) 1958.Crossref 2. Trinkle, J.K.; Rush, B.F.; and Eiseman, B.: Lactate Metabolism Following Hemorrhage , Surg Forum 18:1-21, 1967. 3. Rush, B., and Eiseman, B.: Limits of Non-Colloid Solution Replacement in Experimental Hemorrhagic Shock , Ann Surg 165:977-984 ( (June) ) 1967.Crossref 4. Cori, C.F., and Cori, G.T.: Glycogen Formation in the Liver From D- and L-Lactic Acid , J Biol Chem 81:389-403 (Feb) 1929. 5. Levy, M.N.: Uptake of Lactate and Pyruvate by Intact Kidney of the Dog , Amer J Physiol 202:302-308 ( (Feb) ) 1962. 6. Evans, C.L., et al: The Utilization of Blood Sugar and Lactate by the Heart-Lung Preparation , J Physiol 80:21-40 ( (Nov) ) 1934. 7. Eiseman, B., et al: Isolated Liver Perfusion for Reducing Blood Ammonia , Arch Surg 83:356-363 ( (Sept) ) 1961.Crossref 8. Olson, G.F.: Optimal Conditions for the Enzymatic Determination of L-Lactic Acid , Clin Chem 8:1-10 ( (Feb) ) 1962. 9. Tait, I.B., and Eiseman, B.: Perfusion Dynamics for Extracorporeal Hepatic Assist , Arch Surg 93:131-141 ( (July) ) 1966.Crossref 10. Mahler, H.R., and Cordes, E.H.: Biological Chemistry , New York: Harper & Row Publishers, Inc., 1966, p 411. 11. McShan, W.H., et al: Biological Energy Transformations During Shock as Shown by Blood Chemistry , Amer J Physiol 145:93-106 ( (Nov) ) 1945. 12. Shubin, H., and Weil, M.H.: Acute Elevation of Serum Transaminase and Lactic Dehydrogenase During Circulatory Shock , Amer J Cardiol 11:327-331 ( (March) ) 1963.Crossref 13. Alpert, N.R.: Lactate Production and Removal and the Regulation of Metabolism , Ann NY Acad Sci 119:995-1012 ( (July 31) ) 1965.Crossref 14. Harris, P.; Bateman, M.; and Gloster, J.: Relations Between the Cardio-Respiratory Effects of Exercise and the Arterial Concentration of Lactate and Pyruvate in Patients with Rheumatic Heart Disease , Clin Sci 23:531 ( (March) ) 1962. 15. Olson, R.E.: "Excess Lactate" and Anaerobiosis , Ann Intern Med 59:960-963 ( (Dec) ) 1963.Crossref 16. LePage, G.A.: Biological Energy Transformations During Shock as Shown by Tissue Analyses , Amer J Physiol 146:267-281 ( (May) ) 1946. 17. Kovach, A.G.B., and Fonyo, A.: The Biochemical Response to Injury , H. B. Stomer (ed.), Springfield, Ill: Charles C Thomas, Publisher 1960, p 145. 18. Dahl, N.A., and Balfour, W.M.: Prolonged Anoxic Survival due to Preexposure to Anoxia: Brain ATP and Lactate Changes , Fed Proc 22:2823 ( (March) -April) 1963. 19. Swenson, O., et al: Immediate and Long-Term Effects of Acute Hepatic Ischemia , Arch Surg 95:451-463 ( (Sept) ) 1967.Crossref 20. Talaat, S.M.; Massion, W.H.; and Schilling, J.A.: Effects of ATP Administration in Irreversible Hemorrhagic Shock , Surgery 55:813-819 ( (June) ) 1964. 21. Sharma, G.P., and Eiseman, B.: Protective Effect of ATP in Experimental Hemorrhagic Shock , Surgery 59:66-75 ( (Jan) ) 1966. 22. Huckabee, W.E.: Abnormal Resting Blood Lactate: II. Lactic Acidosis , Amer J Med 30:840-848 ( (June) ) 1961.Crossref 23. Tianquada, R.E.; Grant, W.J.; and Peterson, C.R.: Lactic Acidosis , Arch Intern Med 117:192-202 ( (Feb) ) 1966.Crossref 24. Hartmann, A.F., and Senn, M.J.E.: Studies in the Metabolism of Sodium r-Lactate: I. Response of Normal Human Subjects to the Intravenous Injection of Sodium r-Lactate , J Clin Invest 11:327-335 ( (March) ) 1932.Crossref 25. Wasserman, K., Burton, G.G., and Von Kessel, A.L.: Excess Lactate Concept and Oxygen Debt of Exercise , J Appl Physiol 20:1299-1306 ( (Nov) ) 1961. 26. Collins, J.A.: Some Observations on Acid-Base Balance in Combat Casualties, section G, Surgical Research Team, Vietnam, Walter Reed Army Institute of Research (Jan 9) 1967. 27. Laug, E.P.: Observations on Lactic Acid, Total CO2, and pH of Venous Blood During Recovery From Severe Exercise , Amer J Physiol 107:687-692 ( (March) ) 1934. 28. Bruce, R.A.; Jones, J.W.; and Strait, G.B.: Anaerobic Metabolic Responses to Acute Maximal Exercise in Male Athletes Amer Heart J 67:643-650 ( (May) ) 1964.Crossref 29. Marshall, R.J., and Darby, T.D.: Shock: Pharmacological Principles in Treatment , Springfield, Ill: Charles C Thomas, Publisher, 1966, p 10. 30. Pitts, F.N., and McClure, J.N.: Lactate Metabolism in Anxiety Neurosis , New Eng J Med 277:1329-1336 ( (Dec 21) ) 1967. 31. Goldblatt, M.W.: Ergotamine and the Effect of Adrenalin on Blood Lactate , J Physiol 78:96-105 ( (April) ) 1933. 32. Newman, E.V., et al: The Rate of Lactic Acid Removal in Exercise , Amer J Physiol 118:457-462 ( (March) ) 1937. 33. Drury, D.R., and Wick, A.N.: Chemistry and Metabolism of L (+) and D (−) Lactic Acids , Ann NY Acad Sci 119:1061-1069 ( (July 31) ) 1965.Crossref 34. Dunlop, R.H., and Hammond, P.B.: D-Lactic Acidosis of Ruminants , Ann NY Acad Sci 119:1109-1132 ( (July 31) ) 1965.Crossref 35. Alpert, N.R., and Root, W.S.: Relationship Between Excess Respiratory Metabolism and Utilization of Intravenously Infused Sodium Racemic Lactate and Sodium L (-) Lactate , Amer J Physiol 177:455-462 ( (June) ) 1954. 36. Margaria, R., and Edwards, H.T.: The Removal of Lactic Acid From the Body During Recovery From Muscular Exercise , Amer J Physiol 107:681-686 ( (March) ) 1934. 37. Brin, M.: The Synthesis and Metabolism of Lactic Acid Isomers , Ann NY Acad Sci 119:942-956 ( (July 31) ) 1965.Crossref 38. Rosenburg, J.C., and Rush, B.F.: An Enzymatic-Spectrophotometric Determination of Pyruvic and Lactic Acid in Blood , Clin Chem 12:299-307 ( (May) ) 1966. 39. Lockwood, L.B.; Yoder, D.E.; and Zienty, M.: Lactic Acid , Ann NY Acad Sci 119:854-867 ( (July 31) ) 1965.Crossref 40. Trudnowski, R.J.: Hydration With Ringer's Lactate Solution , JAMA 195:545-548 ( (Feb 14) ) 1966.Crossref 41. Fogelman, M.J., and Wilson, B.J.: A Different Concept of Volume Replacement in Traumatic Hypovolemia , Amer J Surg 99:694-701 ( (May) ) 1960.Crossref 42. Dillon, J., et al: The Treatment of Hemorrhagic Shock , Surg Gynec Obstet 122:967-978 ( (May) ) 1966. 43. Baue, A.E., et al: Hemodynamic and Metabolic Effects of Ringer's Lactate Solution in Hemorrhagic Shock , Ann Surg 166:29-38 ( (July) ) 1967.Crossref 44. Hartmann, A.F., and Senn, J.E.: Studies in Metabolism of Sodium r-Lactate: II. Response of Human Subjects With Acidosis to the Intravenous Injection of Sodium 4-Lactate , J Clin Invest 11:337-344 (March) 1932.Crossref 45. Hoffman, W.S.: The Biochemistry of Clinical Medicine , ed 3, Chicago: Year Book Medical Publishers, Inc. 1964, p 228. 46. Moore, D., and Bernhard, W.F.: Efficacy of Tris Buffer in the Management of Metabolic Lacticacidosis Accompanying Prolonged Hypothermie Perfusions , Surgery 52:905-912 ( (Dec) ) 1962. 47. Bunker, J.P., et al: Citric Acid Intoxication , JAMA 157:1361-1367 ( (April 16) ) 1955.Crossref 48. Bunker, J.P.; Bendixon, H.H.; and Murphy, A.J.: Hemodynamic Effects of Intravenously Administered Sodium Citrate , New Eng J Med 266:372-377 ( (Feb 22) ) 1962.Crossref 49. Howland, W.S., et al: Massive Blood Replacement: V. Failure to Observe Citrate Intoxication , Surg Gynec Obstet 105:529-540 ( (Nov) ) 1957. 50. Torrance, H.B.: The Control of the Hepatic Arterial Circulation , J Physiol 158:39-49 ( (Sept) ) 1961. 51. Schimassek, H.: Lactate Metabolism in the Isolated Perfused Rat Liver , Ann NY Acad Sci 119:1013-1028 ( (July 31) ) 1965.Crossref 52. Vang, J.O., and Drapanas, T.: Metabolism of Lactic Acid and Keto Acids by the Isolated Perfused Calf Liver , Ann Surg 163:545-552 ( (April) ) 1966.Crossref 53. Fine, J.: " The Liver in Traumatic Shock ," in Brauer, R.W. (ed.): Liver Function , Washington, DC: American Institute of Biological Sciences, 1958, p 586. 54. Schimassek, H: Perfusion of Isolated Rat Liver With a Semisynthetic Medium and Control of Liver Function , Life Sci 2:629-634 ( (Sept) ) 1962.Crossref 55. Ballinger, W.F.; Vollenweider, H.; and Montgomery, E.H.: The Response of the Canine Liver to Anaerobic Metabolism Induced by Hemorrhagic Shock , Surg Gynec Obstet 112:19-26 ( (Jan) ) 1961. 56. Eldridge, F.: Blood Lactate and Pyruvate in Pulmonary Insufficiency , New Eng J Med 274:878-883 ( (April 21) ) 1966.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1969

There are no references for this article.