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37 Cards in this Set
- Front
- Back
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How can we use lactate in large animal medicine?
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Look at lactate as a resuscitative end point
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When is lactate produced?
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During hypoxia, in hypoperfused tissues
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Is lactate production an abnormal thing?
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No, there is normal production of lactate
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What 5 tissues are most responsible for lactate production?
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1) Skin
2) Heart 3) Brain 4) Muscle 5) Blood (bc don't have mitochondria) |
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Is lactate consumption or clearance a more technically correct for lactate elimination from the body?
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Consumption is better term than clearance bc clearance means something is excreted
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What is the primary site of lactate consumption? 2nd highest?
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1) Liver*** -primary
2) Kidney -if high enough kidney will excrete some |
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What are 4 ways that hyperlactemia and sepsis are interrelated?
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1) Bacterial production of lactate
2) Can have a degree of hypoperfusion w/ septic animal but not always 3) Leukocytosis -increased WBCs produce lactate 4) Basal metabolic rate of animal is increased |
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What are the 2 types of hyperlactemia?
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Type A and Type B
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What is type B hyperlactemia?
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Lactate production from drugs and mitochondrial dysfunction
e.g. acetylsalicylic acid |
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What is type A hyperlactemia?
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Lactate production from hypoxia, hypoperfusion
-what we're dealing w/ most |
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You are dealing with a septic animal and you know that the metabolic processes are increased so you have given fluids and vasopressors so the animal has adequate perfusion. However, the animal has still has increased lactate levels. What are 2 possible explanations?
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1) Decreased consumption/ elimination
e.g. liver or kidney dysfunction 2) Can be produced aerobically as well as anaerobically in some situations |
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*****When an animal has increased lactate does this mean it has hypoperfusion or hypoxia?
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NO! the two don't necessarily go hand in hand
-DO NOT KEEP TURNING FLUIDS UP BC HAVE HYPERLACTEMIA |
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What is an example of using lactate as an end point for fluids?
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Fluids were administered and we must be good because now the lactate levels are normal (end point we're trying to reach)
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True or false. Lactate is a pretty sensitive test for perfusion.
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False!!! there's other ways that lactate comes into play other than hypoperfusion (type A and type B)
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How can lactate be useful for treatment purposes?
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Can monitor lactate levels periodically to see if levels are decreasing with treatment, to monitor how we're eliminating/ consuming lactate
-Start w/ X level then at certain time your= X - measured |
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Is the absolute level of lactate very useful?
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Yes, can compare it to known levels
-if its greater than this level it's a more dramatic reflection of the degree of ischemia -e.g. small animals that have hyperlactemia from severe hypoperfusion is greater than 5mMol |
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The absolute level of lactate can be used as a _______ indicator.
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Prognostic
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Can a consistent lactate level provide any information?
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Yes, if there' s a lack of a change in lactate levels and you're doing everything possible for resuscitation then it's a poor prognostic indicator
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What can the rate of lactate level fluctuation provide information?
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If lactate levels are quickly going up and doing everything you can= poor prognostic indicator
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Give an example of a goal oriented therapy using lactate as an end point resuscitation?
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Like to see a 50% drop in lactate in 6-8 hour block of time
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What is a disease of small animal medicine where lactate levels are commonly used to monitor the patient?
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GDV: if lactate comes down in 6 hours= marked improvement in their survive
-just has to decrease not normalize |
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Why can lactate levels increase as you are giving fluids?
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Increased perfusion to the hypoxic conditions at the tissue so gathers up all the lactate and returns it to the system
-so if started high & got higher= bad sign |
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Can you give LRS to an animal that is hyperlactemic?
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Yes, it's ok, it does not contribute to lactemia
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What is the best thing to look for when using lactate as an end point of resuscitation?
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Drop in lactate
-but have to set the goals of a certain time, has to be a short amount of time -can't be presenting levels, have to keep monitoring |
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Can you estimate how long an animal is going to live based off of the lactate levels?
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NO! have to have high specificity and sensitivity and lactate does not carry enough sensitivity to say this level means you will live this long
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If someone says that you have lactic acidosis is that the same as hyperlactemia?
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No! not the same thing and not equal
-lactate is a dissociation of lactic acid, lactate is a buffer, free H+ is what causes problem w/ lactic acidosis, lactate acts as the buffer |
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What does increased lactate in other fluids such as abdominal fluid normally indicate?
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Most of time indicators of poor perfusion (ischemia) or indication of sepsis (pleuritis, septic peritonitis)
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A horse comes in with abdominal pain/ discomfort and an abdominocentesis is performed. What do we look at ?
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1) WBC count
2) Lactate levels 3) Protein levels 4) Glucose |
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How do we utilize the absolute value of lactate levels from an abdominocentesis?
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Absolute value is not as important as the ratio of the abdominal fluid lactate to peripheral lactate
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When do abdominal lactate levels most commonly indicate poor perfusion?
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When the the abdominal fluid is about double that of peripheral it most commonly indicates poor perfusion
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What type of a fluid is abdominal fluid?
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Ultrafiltrate, like blood & CSF
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How long does it take abdominal fluid to equilibrate to the peripheral system?
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~24 hours
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Why do horses with peritonitis have increased lactate levels?
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WBCs are producing lactate
-so if increased lactate in abdomen keep peritonitis in back of mind |
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You perform an abdominocentesis and the results say that lactate levels are up and glucose levels are down, what is a top differential?
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Sepsis
-bacteria are consuming glucose and WBCs are producing lactate -but was a case with high lactate and low glucose and was liver torsion-CONSIDER EVERYTHING IN ABDOMEN W/ ABDOMINOCENTESIS |
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When are lactate levels in abdominal fluids helpful?
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When on the fence of whether an animal needs surgical correction
-don't look at one number of lactate values alone!!!!!!!!!!!!!!! |
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Anytime you find a distended SI in large animals it is a surgical issue bc it is a _______ problem.
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Strangulating
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What are 4 drugs that have been associated to hyperlactemia in small animals?
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1) Ethylene glycol
2) Propylene glycol 3) Salicylates 4) Acetaminophen -increased lactate not always hypoperfusion!! |
