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Báo cáo y học: "Where does the lactate come from? A rare cause of reversible inhibition of mitochondrial respiration"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Where does the lactate come from? A rare cause of reversible inhibition of mitochondrial respiration. | Levy et al. Critical Care 2010 14 136 http ccforum.eom content 14 2 136 CRITICAL CARE COMMENTARY L__ Where does the lactate come from A rare cause of reversible inhibition of mitochondrial respiration Bruno Levy Pierre Perez and Jessica Perny See related research by Protti etal. http ccforum.eom content 14 1 R22 Abstract Biguanide poisoning is associated with lactic acidosis. The exact mechanism of biguanide-induced lactic acidosis is not well understood. In the previous issue of Critical Care Protti and colleagues demonstrated that biguanide-induced lactic acidosis may be due in part to a reversible inhibition of mitochondrial respiration. Thus in the absence of an antidote increased drug elimination through dialysis is logical. In the previous issue of Critical Care Protti and colleagues presented a series of patients with severe hyperlactatemia secondary to biguanide intoxication 1 . Traditionally hyperlactatemia in critically ill patients -and particularly those in shock - was normally interpreted as a marker of secondary anaerobic metabolism due to inadequate oxygen supply inducing cellular distress 2 . This view has recently been challenged with the demonstration that during shock states lactate production is at least in part linked to an increased aerobic glycolysis through P2 stimulation 3 . We recently demonstrated in a rat model that this mechanism occurs not only during sepsis high or normal blood flow but also during hemorrhagic shock low blood flow 4 . In clinical practice there are clearly certain situations where hyperlactatemia is predominantly a reflection of tissue hypoperfusion with subsequent anaerobic metabolism. Shock states induced by low cardiac output should theoretically be accompanied by hypoxic hyperlac-tatemia. Cardiogenic shock as demonstrated previously 5 is associated with hyperlactatemia with a very high lactate pyruvate ratio. In theory hemorrhagic shock should behave in an identical fashion. Nevertheless hemorrhagic shock