Clinical Value of Lactate Concentration in Blood Plasma at the Patients with the Signs of Sepsis (Literature Review with Own Findings)

V.V. Nikonov, S.V. Kursov

Abstract


The first part of the article provides a literary review devoted to the study of lactate concentration in blood plasma at the patients with sepsis. It has been noted that despite various reasons of lactacidemia including severe stress, the usage of beta-adrenomimetics, an increased motional activity, tremor, spasms, infusions of fructose, ethanol, polyatomic alcohols, the usage of a high dose of glucose, liver pathology etc., at the patients with sepsis it more often reflects the presence of tissue hypoperfusion and that of severe failure of energy production resulting from mitochondrion dysfunction. High indices of lactate concentration in the blood plasma at the patients with sepsis, the absence of lactate clearance are unfavorable forecasting signs and are often connected with a high possibility of lethal outcomes.
The second part of the article presents the outcomes of the research of lactate concentration in blood plasma at 101 patients with abdominal sepsis on the first, third and fifth day after the operation. The research groups were formed in accordance with the estimation level of the patient’s state severity according to the scale Acute Physiology And Chronic Health Evaluation-II (APACHE-II) (not more than 10 grades, 11-20 grades, more than 20 grades) and to the qualitative composition of fluid resuscitation (only crystalloids, the combination of crystalloids with a 4 % solution of modified gelatine, the combination of crystalloids with a 6 % hydroxiethylstarch (HES) 200/0.5, the combination of crystalloids with the HES solution 130/0.42).
It has been revealed that lactate concentration increased with the value of the state severity estimation according to the scale APACHE-II at the patients with sepsis. The composition of fluid resuscitation has not influenced the normalization dynamics of the lactate level at the patients with the state severity estimation of not more than 10 grades. At the patients with the state severity estimation within 11-20 grades, the inclusion of colloid plasma substitutes on the basis of HES to the fluid resuscitation, in comparison with the crystalloid solutions only, provided for a lower lactate concentration in plasma and for its faster normalization. At the patients with the state severity estimation more than 20 grades the usage of all colloid plasma substitutes for the lactate level normalization has shown the advantage over the infusion of crystalloids only. All patients (n=3) with the established lactate concentration in blood plasma exceeding 4.0 mmole/l have died. The normalization of the plasma lactate level occurred faster at the patients with a low state severity estimation according to APACHE-II scale. In lowering the severity of lactacidemia, the usage of HES derivatives had an advantage over modified gelatine.


Keywords


abdominal sepsis; lactate; lactacidemia; fluid resuscitation; crystalloids; modified gelatine; hydroxiethylstarch

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DOI: https://doi.org/10.22141/2224-0586.4.51.2013.89293

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