Korean Journal of Nephrology 2002;21(1):47-54.

원저 : 간경변증 환자에서의 혈장 D-lactate 농도와 산염기 장애 (Original articles : The Study of Plasma D-lactate Level and Acid - base Imbalance in Cirrhotic Patients)

이동규(Dong Kyu Lee),유준호(Jun Ho Ryu),한상웅(Sang Woong Han),김호중(Ho Jung Kim),박일규(Ile Kyu Park),손주현(Joo Hyun Sohn),기춘석(Choon Suk Kee)

Abstract

Purpose
: D-lactate, optical isomer of L-lactate is not a human metabolite. Once the D-lactate enters the human body, it is mainly metabolized in liver. The metabolism of D-lactate can be changed in patients with decompensated liver cirrhosis with the exposure of antibiotics and the frequent trial of lactulose, if neccessory. The aim of this study is to analyze blood D-lactate level in cirrhotic patients and it's relationship with the degree of hepatic insufficiency and acid-base imbalance. Methods : Plasma L-lactate and D-lactate levels were measured in 40 cirrhotic patients classified by Child-Pugh system with L-LDH and D-LDH with comparison of their changes before and after the use of antibiotics and lactulose(n=14). Also, acid-base disorders were analyzed in 35 cirrhotic patients, and plasma L, D-lactate levels were determined in each acid-base disorder. Results : Plasma D-lactate level was not significantly elevated in cirrhotic patients compared to the control group(2.34±0.48 mmol/L vs. 1.63±0.26 mmol/ L, p=NS), but some patients(n=4, 10%) revealed abnormally elevated D-lactate level. The plasma L, D- lactate levels were not different in subgroups classified by Child-Pugh system as well as by underlying causes of liver cirrhosis, and plasma D-lactate level was not sugnificnatly different before and after the exposure of antibiotics and lactulose. Plasma D-lactate level was significantly increased in 3 patients with respiratory alkalosis and metabolic acidosis(12±2.98 mmol/L) compared to others(p<0.05). Conclusion : These results suggest that, regardless of its decompensated degree and exposure to drugs, a subset of patients with liver cirrhosis can develop elevation of D-lactate in blood, particularly when metabolic acidosis is accompanied. (Korean J Nephrol 2002;21(1):47-54)