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Glenn Hernandez - One of the best experts on this subject based on the ideXlab platform.
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capillary refill time during fluid resuscitation in patients with sepsis related Hyperlactatemia at the emergency department is related to mortality
PLOS ONE, 2017Co-Authors: Barbara Lara, Ricardo Castro, Eduardo Kattan, Luis Enberg, Marcos Ortega, Paula Leon, Cristobal Kripper, Pablo Aguilera, Jan Bakker, Glenn HernandezAbstract:Introduction Acute circulatory dysfunction in patients with sepsis can evolve rapidly into a progressive stage associated with high mortality. Early recognition and adequate resuscitation could improve outcome. However, since the spectrum of clinical presentation is quite variable, signs of hypoperfusion are frequently unrecognized in patients just admitted to the emergency department (ED). Hyperlactatemia is considered a key parameter to disclose tissue hypoxia but it is not universally available and getting timely results can be challenging in low resource settings. In addition, non-hypoxic sources can be involved in Hyperlactatemia, and a misinterpretation could lead to over-resuscitation in an unknown number of cases. Capillary refill time (CRT) is a marker of peripheral perfusion that worsens during circulatory failure. An abnormal CRT in septic shock patients after ICU-based resuscitation has been associated with poor outcome. The aim of this study was to determine the prevalence of abnormal CRT in patients with sepsis-related Hyperlactatemia in the early phase after ED admission, and its relationship with outcome. Methods We performed a prospective observational study. Septic patients with hyperlactemia at ED admission subjected to an initial fluid resuscitation (FR) were included. CRT and other parameters were assessed before and after FR. CRT-normal or CRT-abnormal subgroups were defined according to the status of CRT following initial FR, and major outcomes were registered. Results Ninety-five hyperlactatemic septic patients were included. Thirty-one percent had abnormal CRT at ED arrival. After FR, 87 patients exhibited normal CRT, and 8 an abnormal one. Patients with abnormal CRT had an increased risk of adverse outcomes (88% vs. 20% p<0.001; RR 4.4 [2.7–7.4]), and hospital mortality (63% vs. 9% p<0.001; RR 6.7 [2.9–16]) as compared to those with normal CRT after FR. Specifically, CRT-normal patients required less frequently mechanical ventilation, renal replacement therapy, and ICU admission, and exhibited a lower hospital mortality. Conclusions Hyperlactatemic sepsis patients with abnormal CRT after initial fluid resuscitation exhibit higher mortality and worse clinical outcomes than patients with normal CRT.
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effects of dexmedetomidine and esmolol on systemic hemodynamics and exogenous lactate clearance in early experimental septic shock
Critical Care, 2016Co-Authors: Glenn Hernandez, Leyla Alegria, Dagoberto Soto, Jussara Gomez, Nicolas Jarufe, Pablo Achurra, Rolando Rebolledo, Cecilia Luengo, Pablo Tapia, Alejandro BruhnAbstract:Background Persistent Hyperlactatemia during septic shock is multifactorial. Hypoperfusion-related anaerobic production and adrenergic-driven aerobic generation together with impaired lactate clearance have been implicated. An excessive adrenergic response could contribute to persistent Hyperlactatemia and adrenergic modulation might be beneficial. We assessed the effects of dexmedetomidine and esmolol on hemodynamics, lactate generation, and exogenous lactate clearance during endotoxin-induced septic shock.
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persistent sepsis induced hypotension without Hyperlactatemia a distinct clinical and physiological profile within the spectrum of septic shock
Critical Care Research and Practice, 2012Co-Authors: Glenn Hernandez, Alejandro Bruhn, Ricardo Castro, Eduardo Kattan, Cesar Pedreros, Maximiliano Rovegno, Enrique Veas, Andrea Fuentealba, Tomas Regueira, Carolina RuizAbstract:Introduction. A subgroup of septic shock patients will never develop Hyperlactatemia despite being subjected to a massive circulatory stress. Maintenance of normal lactate levels during septic shock is of great clinical and physiological interest. Our aim was to describe the clinical, hemodynamic, perfusion, and microcirculatory profiles associated to the absence of Hyperlactatemia during septic shock resuscitation. Methods. We conducted an observational study in septic shock patients undergoing resuscitation. Serial clinical, hemodynamic, and perfusion parameters were registered. A single sublingual microcirculatory assessment was performed in a subgroup. Patients evolving with versus without Hyperlactatemia were compared. Results. 124 septic shock patients were included. Patients without Hyperlactatemia exhibited lower severity scores and mortality. They also presented higher platelet counts and required less intensive treatment. Microcirculation was assessed in 45 patients. Patients without Hyperlactatemia presented higher PPV and MFI values. Lactate was correlated to several microcirculatory parameters. No difference in systemic flow parameters was observed. Conclusion. Persistent sepsis-induced hypotension without Hyperlactatemia is associated with less organ dysfunctions and a very low mortality risk. Patients without Hyperlactatemia exhibit less coagulation and microcirculatory derangements despite comparable macrohemodynamics. Our study supports the notion that persistent sepsis-induced hypotension without Hyperlactatemia exhibits a distinctive clinical and physiological profile.
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persistent sepsis induced hypotension without Hyperlactatemia is it really septic shock
Journal of Critical Care, 2011Co-Authors: Glenn Hernandez, Ricardo Castro, Carlos Romero, Claudio De La Hoz, Daniela Angulo, Ignacio Aranguiz, Jorge Larrondo, Andres Bujes, Alejandro BruhnAbstract:Abstract Purpose The prognostic value of Hyperlactatemia in septic shock is unquestionable. However, as current definitions do not include Hyperlactatemia as a mandatory criterion, some hypotensive patients may be diagnosed as having septic shock despite exhibiting normolactatemia. The significance of persistent sepsis-induced hypotension without Hyperlactatemia is unclear. Is it really septic shock? Our aim was to determine differences in outcome between patients diagnosed as having septic shock but exhibiting normal vs elevated lactate levels during evolution. We also explored the potential implications of including Hyperlactatemia as an obligatory diagnostic criterion. Methods We performed retrospective analyses on a cohort of 302 septic shock patients. Results When we divided patients according to the presence of Hyperlactatemia, 34% evolved without Hyperlactatemia and exhibited a very low mortality risk (7.7% compared with 42.9% of those with Hyperlactatemia). These patients also presented less severe organ dysfunctions and higher central venous O2 saturation values, and required lower norepinephrine doses. The potential inclusion of Hyperlactatemia in septic shock definition would reduce incidence in 34% but increase absolute mortality risk in 11%. Conclusions Persistent sepsis-induced hypotension without Hyperlactatemia may not constitute a real septic shock. Our results support the need to review the current definition of septic shock. Hyperlactatemia could represent an objective parameter worth to be explored as a potential diagnostic criterion for septic shock.
Alejandro Bruhn - One of the best experts on this subject based on the ideXlab platform.
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effects of dexmedetomidine and esmolol on systemic hemodynamics and exogenous lactate clearance in early experimental septic shock
Critical Care, 2016Co-Authors: Glenn Hernandez, Leyla Alegria, Dagoberto Soto, Jussara Gomez, Nicolas Jarufe, Pablo Achurra, Rolando Rebolledo, Cecilia Luengo, Pablo Tapia, Alejandro BruhnAbstract:Background Persistent Hyperlactatemia during septic shock is multifactorial. Hypoperfusion-related anaerobic production and adrenergic-driven aerobic generation together with impaired lactate clearance have been implicated. An excessive adrenergic response could contribute to persistent Hyperlactatemia and adrenergic modulation might be beneficial. We assessed the effects of dexmedetomidine and esmolol on hemodynamics, lactate generation, and exogenous lactate clearance during endotoxin-induced septic shock.
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persistent sepsis induced hypotension without Hyperlactatemia a distinct clinical and physiological profile within the spectrum of septic shock
Critical Care Research and Practice, 2012Co-Authors: Glenn Hernandez, Alejandro Bruhn, Ricardo Castro, Eduardo Kattan, Cesar Pedreros, Maximiliano Rovegno, Enrique Veas, Andrea Fuentealba, Tomas Regueira, Carolina RuizAbstract:Introduction. A subgroup of septic shock patients will never develop Hyperlactatemia despite being subjected to a massive circulatory stress. Maintenance of normal lactate levels during septic shock is of great clinical and physiological interest. Our aim was to describe the clinical, hemodynamic, perfusion, and microcirculatory profiles associated to the absence of Hyperlactatemia during septic shock resuscitation. Methods. We conducted an observational study in septic shock patients undergoing resuscitation. Serial clinical, hemodynamic, and perfusion parameters were registered. A single sublingual microcirculatory assessment was performed in a subgroup. Patients evolving with versus without Hyperlactatemia were compared. Results. 124 septic shock patients were included. Patients without Hyperlactatemia exhibited lower severity scores and mortality. They also presented higher platelet counts and required less intensive treatment. Microcirculation was assessed in 45 patients. Patients without Hyperlactatemia presented higher PPV and MFI values. Lactate was correlated to several microcirculatory parameters. No difference in systemic flow parameters was observed. Conclusion. Persistent sepsis-induced hypotension without Hyperlactatemia is associated with less organ dysfunctions and a very low mortality risk. Patients without Hyperlactatemia exhibit less coagulation and microcirculatory derangements despite comparable macrohemodynamics. Our study supports the notion that persistent sepsis-induced hypotension without Hyperlactatemia exhibits a distinctive clinical and physiological profile.
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persistent sepsis induced hypotension without Hyperlactatemia is it really septic shock
Journal of Critical Care, 2011Co-Authors: Glenn Hernandez, Ricardo Castro, Carlos Romero, Claudio De La Hoz, Daniela Angulo, Ignacio Aranguiz, Jorge Larrondo, Andres Bujes, Alejandro BruhnAbstract:Abstract Purpose The prognostic value of Hyperlactatemia in septic shock is unquestionable. However, as current definitions do not include Hyperlactatemia as a mandatory criterion, some hypotensive patients may be diagnosed as having septic shock despite exhibiting normolactatemia. The significance of persistent sepsis-induced hypotension without Hyperlactatemia is unclear. Is it really septic shock? Our aim was to determine differences in outcome between patients diagnosed as having septic shock but exhibiting normal vs elevated lactate levels during evolution. We also explored the potential implications of including Hyperlactatemia as an obligatory diagnostic criterion. Methods We performed retrospective analyses on a cohort of 302 septic shock patients. Results When we divided patients according to the presence of Hyperlactatemia, 34% evolved without Hyperlactatemia and exhibited a very low mortality risk (7.7% compared with 42.9% of those with Hyperlactatemia). These patients also presented less severe organ dysfunctions and higher central venous O2 saturation values, and required lower norepinephrine doses. The potential inclusion of Hyperlactatemia in septic shock definition would reduce incidence in 34% but increase absolute mortality risk in 11%. Conclusions Persistent sepsis-induced hypotension without Hyperlactatemia may not constitute a real septic shock. Our results support the need to review the current definition of septic shock. Hyperlactatemia could represent an objective parameter worth to be explored as a potential diagnostic criterion for septic shock.
Ricardo Castro - One of the best experts on this subject based on the ideXlab platform.
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capillary refill time during fluid resuscitation in patients with sepsis related Hyperlactatemia at the emergency department is related to mortality
PLOS ONE, 2017Co-Authors: Barbara Lara, Ricardo Castro, Eduardo Kattan, Luis Enberg, Marcos Ortega, Paula Leon, Cristobal Kripper, Pablo Aguilera, Jan Bakker, Glenn HernandezAbstract:Introduction Acute circulatory dysfunction in patients with sepsis can evolve rapidly into a progressive stage associated with high mortality. Early recognition and adequate resuscitation could improve outcome. However, since the spectrum of clinical presentation is quite variable, signs of hypoperfusion are frequently unrecognized in patients just admitted to the emergency department (ED). Hyperlactatemia is considered a key parameter to disclose tissue hypoxia but it is not universally available and getting timely results can be challenging in low resource settings. In addition, non-hypoxic sources can be involved in Hyperlactatemia, and a misinterpretation could lead to over-resuscitation in an unknown number of cases. Capillary refill time (CRT) is a marker of peripheral perfusion that worsens during circulatory failure. An abnormal CRT in septic shock patients after ICU-based resuscitation has been associated with poor outcome. The aim of this study was to determine the prevalence of abnormal CRT in patients with sepsis-related Hyperlactatemia in the early phase after ED admission, and its relationship with outcome. Methods We performed a prospective observational study. Septic patients with hyperlactemia at ED admission subjected to an initial fluid resuscitation (FR) were included. CRT and other parameters were assessed before and after FR. CRT-normal or CRT-abnormal subgroups were defined according to the status of CRT following initial FR, and major outcomes were registered. Results Ninety-five hyperlactatemic septic patients were included. Thirty-one percent had abnormal CRT at ED arrival. After FR, 87 patients exhibited normal CRT, and 8 an abnormal one. Patients with abnormal CRT had an increased risk of adverse outcomes (88% vs. 20% p<0.001; RR 4.4 [2.7–7.4]), and hospital mortality (63% vs. 9% p<0.001; RR 6.7 [2.9–16]) as compared to those with normal CRT after FR. Specifically, CRT-normal patients required less frequently mechanical ventilation, renal replacement therapy, and ICU admission, and exhibited a lower hospital mortality. Conclusions Hyperlactatemic sepsis patients with abnormal CRT after initial fluid resuscitation exhibit higher mortality and worse clinical outcomes than patients with normal CRT.
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a hypoperfusion context may aid to interpret Hyperlactatemia in sepsis 3 septic shock patients a proof of concept study
Annals of Intensive Care, 2017Co-Authors: Leyla Alegria, Magdalena Vera, Jorge Dreyse, Ricardo Castro, David Carpio, Carolina Henriquez, Daniela Gajardo, Sebastian Bravo, Felipe Araneda, Eduardo KattanAbstract:Persistent Hyperlactatemia is particularly difficult to interpret in septic shock. Besides hypoperfusion, adrenergic-driven lactate production and impaired lactate clearance are important contributors. However, clinical recognition of different sources of Hyperlactatemia is unfortunately not a common practice and patients are treated with the same strategy despite the risk of over-resuscitation in some. Indeed, pursuing additional resuscitation in non-hypoperfusion-related cases might lead to the toxicity of fluid overload and vasoactive drugs. We hypothesized that two different clinical patterns can be recognized in septic shock patients through a multimodal perfusion monitoring. Hyperlactatemic patients with a hypoperfusion context probably represent a more severe acute circulatory dysfunction, and the absence of a hypoperfusion context is eventually associated with a good outcome. We performed a retrospective analysis of a database of septic shock patients with persistent Hyperlactatemia after initial resuscitation. We defined hypoperfusion context by the presence of a ScvO2 < 70%, or a P(cv-a)CO2 ≥6 mmHg, or a CRT ≥4 s together with Hyperlactatemia. Ninety patients were included, of whom seventy exhibited a hypoperfusion-related pattern and 20 did not. Although lactate values were comparable at baseline (4.8 ± 2.8 vs. 4.7 ± 3.7 mmol/L), patients with a hypoperfusion context exhibited a more severe circulatory dysfunction with higher vasopressor requirements, and a trend to longer mechanical ventilation days, ICU stay, and more rescue therapies. Only one of the 20 hyperlactatemic patients without a hypoperfusion context died (5%) compared to 11 of the 70 with hypoperfusion-related Hyperlactatemia (16%). Two different clinical patterns among hyperlactatemic septic shock patients may be identified according to hypoperfusion context. Patients with Hyperlactatemia plus low ScvO2, or high P(cv-a)CO2, or high CRT values exhibited a more severe circulatory dysfunction. This provides a starting point to launch further prospective studies to confirm if this approach can lead to a more selective resuscitation strategy.
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persistent sepsis induced hypotension without Hyperlactatemia a distinct clinical and physiological profile within the spectrum of septic shock
Critical Care Research and Practice, 2012Co-Authors: Glenn Hernandez, Alejandro Bruhn, Ricardo Castro, Eduardo Kattan, Cesar Pedreros, Maximiliano Rovegno, Enrique Veas, Andrea Fuentealba, Tomas Regueira, Carolina RuizAbstract:Introduction. A subgroup of septic shock patients will never develop Hyperlactatemia despite being subjected to a massive circulatory stress. Maintenance of normal lactate levels during septic shock is of great clinical and physiological interest. Our aim was to describe the clinical, hemodynamic, perfusion, and microcirculatory profiles associated to the absence of Hyperlactatemia during septic shock resuscitation. Methods. We conducted an observational study in septic shock patients undergoing resuscitation. Serial clinical, hemodynamic, and perfusion parameters were registered. A single sublingual microcirculatory assessment was performed in a subgroup. Patients evolving with versus without Hyperlactatemia were compared. Results. 124 septic shock patients were included. Patients without Hyperlactatemia exhibited lower severity scores and mortality. They also presented higher platelet counts and required less intensive treatment. Microcirculation was assessed in 45 patients. Patients without Hyperlactatemia presented higher PPV and MFI values. Lactate was correlated to several microcirculatory parameters. No difference in systemic flow parameters was observed. Conclusion. Persistent sepsis-induced hypotension without Hyperlactatemia is associated with less organ dysfunctions and a very low mortality risk. Patients without Hyperlactatemia exhibit less coagulation and microcirculatory derangements despite comparable macrohemodynamics. Our study supports the notion that persistent sepsis-induced hypotension without Hyperlactatemia exhibits a distinctive clinical and physiological profile.
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persistent sepsis induced hypotension without Hyperlactatemia is it really septic shock
Journal of Critical Care, 2011Co-Authors: Glenn Hernandez, Ricardo Castro, Carlos Romero, Claudio De La Hoz, Daniela Angulo, Ignacio Aranguiz, Jorge Larrondo, Andres Bujes, Alejandro BruhnAbstract:Abstract Purpose The prognostic value of Hyperlactatemia in septic shock is unquestionable. However, as current definitions do not include Hyperlactatemia as a mandatory criterion, some hypotensive patients may be diagnosed as having septic shock despite exhibiting normolactatemia. The significance of persistent sepsis-induced hypotension without Hyperlactatemia is unclear. Is it really septic shock? Our aim was to determine differences in outcome between patients diagnosed as having septic shock but exhibiting normal vs elevated lactate levels during evolution. We also explored the potential implications of including Hyperlactatemia as an obligatory diagnostic criterion. Methods We performed retrospective analyses on a cohort of 302 septic shock patients. Results When we divided patients according to the presence of Hyperlactatemia, 34% evolved without Hyperlactatemia and exhibited a very low mortality risk (7.7% compared with 42.9% of those with Hyperlactatemia). These patients also presented less severe organ dysfunctions and higher central venous O2 saturation values, and required lower norepinephrine doses. The potential inclusion of Hyperlactatemia in septic shock definition would reduce incidence in 34% but increase absolute mortality risk in 11%. Conclusions Persistent sepsis-induced hypotension without Hyperlactatemia may not constitute a real septic shock. Our results support the need to review the current definition of septic shock. Hyperlactatemia could represent an objective parameter worth to be explored as a potential diagnostic criterion for septic shock.
Michael V Oshaughnessy - One of the best experts on this subject based on the ideXlab platform.
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changes in mitochondrial dna as a marker of nucleoside toxicity in hiv infected patients
The New England Journal of Medicine, 2002Co-Authors: Helene C F Cote, Zabrina L Brumme, Kevin J P Craib, Christopher S Alexander, Brian Wynhoven, Lillian Ting, Hubert Wong, Marianne Harris, Richard P Harrigan, Michael V OshaughnessyAbstract:Background Nucleoside analogues can induce toxic effects on mitochondria by inhibiting the human DNA polymerase γ. The toxic effects can range from increased serum lactate levels to potentially fatal lactic acidosis. We studied changes in mitochondrial DNA relative to nuclear DNA in the peripheral-blood cells of patients with symptomatic, nucleoside-induced Hyperlactatemia. Methods Total DNA was extracted from blood cells. A nuclear gene and a mitochondrial gene were quantified by real-time polymerase chain reaction. Three groups were studied: 24 controls not infected with the human immunodeficiency virus (HIV), 47 HIV-infected asymptomatic patients who had never been treated with antiretroviral drugs, and 8 HIV-infected patients who were receiving antiretroviral drugs and had symptomatic Hyperlactatemia. The patients in the last group were studied longitudinally before, during, and after antiretroviral therapy. Results Symptomatic Hyperlactatemia was associated with marked reductions in the ratios of mit...
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changes in mitochondrial dna as a marker of nucleoside toxicity in hiv infected patients
The New England Journal of Medicine, 2002Co-Authors: Helene C F Cote, Zabrina L Brumme, Kevin J P Craib, Christopher S Alexander, Brian Wynhoven, Lillian Ting, Hubert Wong, Marianne Harris, Richard P Harrigan, Michael V OshaughnessyAbstract:Background Nucleoside analogues can induce toxic effects on mitochondria by inhibiting the human DNA polymerase g . The toxic effects can range from increased serum lactate levels to potentially fatal lactic acidosis. We studied changes in mitochondrial DNA relative to nuclear DNA in the peripheral-blood cells of patients with symptomatic, nucleoside-induced Hyperlactatemia. Methods Total DNA was extracted from blood cells. A nuclear gene and a mitochondrial gene were quantified by real-time polymerase chain reaction. Three groups were studied: 24 controls not infected with the human immunodeficiency virus (HIV), 47 HIV-infected asymptomatic patients who had never been treated with antiretroviral drugs, and 8 HIV-infected patients who were receiving antiretroviral drugs and had symptomatic Hyperlactatemia. The patients in the last group were studied longitudinally before, during, and after antiretroviral therapy. Results Symptomatic Hyperlactatemia was associated with marked reductions in the ratios of mitochondrial to nuclear DNA, which, during therapy, averaged 68 percent lower than those of non–HIV-infected controls and 43 percent lower than those of HIV-infected asymptomatic patients never treated with antiretroviral drugs. After the discontinuation of antiretroviral therapy, there was a statistically significant increase in the ratio of mitochondrial to nuclear DNA (P=0.02). In the patients followed longitudinally, the decline in mitochondrial DNA preceded the increase in venous lactate levels. Conclusions Mitochondrial DNA levels are significantly decreased in patients with symptomatic, nucleoside-related Hyperlactatemia, an effect that resolves on the discontinuation of therapy. (N Engl J Med 2002;
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changes in mitochondrial dna as a marker of nucleoside toxicity in hiv infected patients
The New England Journal of Medicine, 2002Co-Authors: Helene C F Cote, Zabrina L Brumme, Kevin J P Craib, Christopher S Alexander, Brian Wynhoven, Lillian Ting, Hubert Wong, Marianne Harris, Richard P Harrigan, Michael V OshaughnessyAbstract:Background Nucleoside analogues can induce toxic effects on mitochondria by inhibiting the human DNA polymerase g . The toxic effects can range from increased serum lactate levels to potentially fatal lactic acidosis. We studied changes in mitochondrial DNA relative to nuclear DNA in the peripheral-blood cells of patients with symptomatic, nucleoside-induced Hyperlactatemia. Methods Total DNA was extracted from blood cells. A nuclear gene and a mitochondrial gene were quantified by real-time polymerase chain reaction. Three groups were studied: 24 controls not infected with the human immunodeficiency virus (HIV), 47 HIV-infected asymptomatic patients who had never been treated with antiretroviral drugs, and 8 HIV-infected patients who were receiving antiretroviral drugs and had symptomatic Hyperlactatemia. The patients in the last group were studied longitudinally before, during, and after antiretroviral therapy. Results Symptomatic Hyperlactatemia was associated with marked reductions in the ratios of mitochondrial to nuclear DNA, which, during therapy, averaged 68 percent lower than those of non–HIV-infected controls and 43 percent lower than those of HIV-infected asymptomatic patients never treated with antiretroviral drugs. After the discontinuation of antiretroviral therapy, there was a statistically significant increase in the ratio of mitochondrial to nuclear DNA (P=0.02). In the patients followed longitudinally, the decline in mitochondrial DNA preceded the increase in venous lactate levels. Conclusions Mitochondrial DNA levels are significantly decreased in patients with symptomatic, nucleoside-related Hyperlactatemia, an effect that resolves on the discontinuation of therapy. (N Engl J Med 2002;
Christopher Junker - One of the best experts on this subject based on the ideXlab platform.
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anion gap anion gap corrected for albumin base deficit and unmeasured anions in critically ill patients implications on the assessment of metabolic acidosis and the diagnosis of Hyperlactatemia
BMC Emergency Medicine, 2008Co-Authors: Lakhmir S Chawla, Christopher Junker, Shirley L Shih, Danielle Davison, Michael G SeneffAbstract:Base deficit (BD), anion gap (AG), and albumin corrected anion gap (ACAG) are used by clinicians to assess the presence or absence of Hyperlactatemia (HL). We set out to determine if these tools can diagnose the presence of HL using cotemporaneous samples. We conducted a chart review of ICU patients who had cotemporaneous arterial blood gas, serum chemistry, serum albumin (Alb) and lactate(Lac) levels measured from the same sample. We assessed the capacity of AG, BD, and ACAG to diagnose HL and severe Hyperlactatemia (SHL). HL was defined as Lac > 2.5 mmol/L. SHL was defined as a Lac of > 4.0 mmol/L. From 143 patients we identified 497 series of lab values that met our study criteria. Mean age was 62.2 ± 15.7 years. Mean Lac was 2.11 ± 2.6 mmol/L, mean AG was 9.0 ± 5.1, mean ACAG was 14.1 ± 3.8, mean BD was 1.50 ± 5.4. The area under the curve for the ROC for BD, AG, and ACAG to diagnose HL were 0.79, 0.70, and 0.72, respectively. AG and BD failed to reliably detect the presence of clinically significant Hyperlactatemia. Under idealized conditions, ACAG has the capacity to rule out the presence of Hyperlactatemia. Lac levels should be obtained routinely in all patients admitted to the ICU in whom the possibility of shock/hypoperfusion is being considered. If an AG assessment is required in the ICU, it must be corrected for albumin for there to be sufficient diagnostic utility.
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anion gap anion gap corrected for albumin and base deficit fail to accurately diagnose clinically significant Hyperlactatemia in critically ill patients
Journal of Intensive Care Medicine, 2008Co-Authors: Lakhmir S Chawla, Dhiraj Jagasia, Lynn M Abell, Michael G Seneff, Melinda Egan, Natale Danino, Aline Nguyen, Mazer Ally, Paul L Kimmel, Christopher JunkerAbstract:Anion gap, anion gap corrected for serum albumin, and base deficit are often used as surrogates for measuring serum lactate. None of these surrogates is postulated to predict Hyperlactatemia in the critically ill. We prospectively collected data from September 2004 through August 2005 for 1381 consecutive admissions. Patients with renal disease, ketoacidosis, or toxic ingestion were excluded. Anion gap, anion gap corrected for albumin, and base deficit were calculated for all patients. We identified 286 patients who met our inclusion or exclusion criteria. The receiver-operating characteristic area under the curve for the prediction of Hyperlactatemia for anion gap, anion gap corrected for albumin, and base deficit were 0.55, 0.57, and 0.64, respectively. Anion gap, anion gap corrected for albumin, and base deficit do not predict the presence or absence of clinically significant Hyperlactatemia. Serum lactate should be measured in all critically ill adults in whom hypoperfusion is suspected.