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lactate_to_pyruvate_ratio

Lactate to Pyruvate Ratio

The blood lactate to pyruvate (L:P) ratio is used to distinguish between pyruvate dehydrogenase deficiency and other causes of congenital lactic acidosis. In conjunction with an elevated lactate, an L:P ratio greater than 30 suggests inherited disorders of the respiratory chain complex or tricarboxylic acid cycle disorders. In conjunction with an elevated lactate, an L:P ratio less than 25 suggests a defect in pyruvate metabolism. An artificially high L:P ratio can be observed in acutely ill individuals. Abnormal concentrations of lactate, pyruvate, and the L:P ratio are not diagnostic for any single disorder and must be interpreted in the context of the individual's clinical presentation and other laboratory studies.

Cerebral cytoplasmatic redox state is a sensitive indicator of cerebral oxidative metabolism and is conventionally evaluated from the extracellular Lactate to Pyruvate Ratio.

During cerebral ischemia induced by severe hemorrhagic shock, intravascular microdialysis of the draining venous blood will exhibit changes of the Lactate to Pyruvate Ratio (LP ratio) revealing the deterioration of global cerebral oxidative energy metabolism. In neurocritical care, this technique might be used to give information regarding global cerebral energy metabolism in addition to the regional information obtained from intracerebral microdialysis catheters. The technique might also be used to evaluate cerebral energy state in various critical care conditions when insertion of an intracerebral microdialysis catheter may be contraindicated, e.g., resuscitation after cardiac standstill, open-heart surgery, and multi-trauma 1).


Early low CBF measurements and a high lactate and lactate/pyruvate ratio may be early warning signs of the risk of developing Delayed cerebral ischemia (DCI). The clinical value of these findings needs to be confirmed in larger studies 2).

1)
Jakobsen R, Halfeld Nielsen T, Granfeldt A, Toft P, Nordström CH. A technique for continuous bedside monitoring of global cerebral energy state. Intensive Care Med Exp. 2016 Dec;4(1):3. doi: 10.1186/s40635-016-0077-2. Epub 2016 Jan 20. PubMed PMID: 26791144.
2)
Rostami E, Engquist H, Howells T, Johnson U, Ronne-Engström E, Nilsson P, Hillered L, Lewén A, Enblad P. Early low cerebral blood flow and high cerebral lactate: prediction of delayed cerebral ischemia in subarachnoid hemorrhage. J Neurosurg. 2017 Jun 2:1-9. doi: 10.3171/2016.11.JNS161140. [Epub ahead of print] PubMed PMID: 28574309.
lactate_to_pyruvate_ratio.txt · Last modified: 2017/06/14 10:57 by administrador