Cerebrospinal fluid lactate

G2. Genton, B., and Berger, J. R, Cerebrospinal fluid lactate in 78 cases of adult meningitis. Intensive Care Med. 16(3), 196-200 (1990). 

Benoit JF, Alberti C, Leclercq S, Rigal O, Jean-Luois R, Ogier de Baulny H, Porquet D, Biou D (2003) cerebrospinal fluid lactate and pyruvate concentration and their ratio in children age-related reference intervals. Clin Chem 49 487-494... 

Lipoprotein fractionation Serum homocysteine Leukocyte a-galactosidase A Blood/cerebrospinal fluid lactate... 

E662 Moriguchi, J., Senn, C. and Freier, E. (1990). Comparison of Kodak Ektachem 700XR and micro centrifugal analyzer for analysis of cerebrospinal fluid lactate. Clin. Chem. 36, 1199, Abstr. 1154. 

Therrien G, Gigufere JF, Butterworth RF. Increased cerebrospinal fluid lactate reflects deterioration of neurological status in experimental portal-systemic encephalopathy. Metab. Brain Dis., 6, 225-231, 1991... 

Wendon JA, Harrison PM, Keays R, Williams R. Cerebral blood flow and metabolism in fulminant liver failure. Hepatology, 19, 1407—1413, 1994 Yao H, Sadoshima S, Fujii K, Kusada K, Ishitsuka T, Tameiki K, Fujishima M. Cerebrospinal fluid lactate in patients with hepatic encephalopathy. Eur. Neurol, 27, 182-187, 1987 Young SN, Lai S. CNS tryptamine metabolism in hepatic coma. J. Neural. Transm., 47,153-161, 1980... 

L2. Leib, S. L., Boscacci, R., Gratzl, O., and Zimmerli, W., Predictive value of cerebrospinal fluid (CSF) lactate level versus CSF/blood glucose ratio for the diagnosis of bacterial meningitis following neurosurgery. Clini. Infect. Dis. 29, 69-74 (1999). 

Lactate and can be measured in blood, plasma, urine and the cerebrospinal fluid (CSF). Pyruvate and ACAC are highly unstable, so deproteinisation is performed immediately after sampling. Lactate, pyruvate, and ACAC determination can be measured in the same sample after deproteinisation using perchloric acid [17]. 

Hutchesson A, Preece MA, Gray G, Green A (1997) Measurement of lactate in cerebrospinal fluid in investigation of inherited metabolic disease. Clin Chem 43 158-161... 

A neonatal form of hepatic failure has a rapidly fatal course and frequently includes severe hypotonia, myoclonus epilepsy, and psychomotor retardation [39]. Another type (found in children aged 2-18 months) has a milder clinical course with infrequent fatal outcome [11]. Abnormal histology (steatosis, micro and macro-nodular cirrhosis) and elevated plasma or cerebrospinal fluid (CSF) lactate are consistent features of the disease, regardless of the clinical subtype. The brain is often involved in these presentations, but other organs could also be involved. Dwarfism... 

Amperometric detection was achieved on two patches of C films (formed by CVD of 3,4,9,10-perylenetetracarboxylie dianhydride) on a glass chip. The microchannels were formed using a 23- im-thick photoresist as a spacer. Glucose oxidase and lactate oxidase were immobilized with HRP on the C films via a coated film of osmium PVPD polymer. Simultaneous measurements of glucose and lactate in rat brain cerebrospinal fluid (first perfused with 50 mM veratridine) were achieved. These two films were spatially separated in order to avoid interdiffusion of H202 formed from the two separate enzymatic reactions. Moreover, the two films were preceded by a third C film immobilized with ascorbate oxidase in order to remove ascorbic acid interference [759]. 

Biotinidase activity in cerebrospinal fluid and the brain is very low. This suggests that the brain may not recycle biotin effectively and depends on biotin transported across the blood-brain barrier. Several symptomatic children who have failed to exhibit peripheral lactic acidosis or organic aciduria have had elevated lactate or organic acids in their cerebrospinal fluid. This compartmentalization of the biochemical abnormalities may explain why the neurological symptoms usually appear before other symptoms. Peripheral metabolic ketoacidosis and organic aciduria subsequently occur with prolonged metabolic compromise. 

Chatterly S, Sun T, Lien Y. Diagnostic value of lactate dehydrogenase isoenzymes in cerebrospinal fluid. J Clin Lab Anal 1991 5 168-74. 

Pryce JD, Gant PW, Sau KJ. Normal concentrations of lactate, glucose, and protein in cerebrospinal fluid, and the diagnostic implications of abnormal concentrations. Clin Chem 1970 16 562-5. 

Inao, S., Marmarou, A., Clarke, G.D., Andersen, B.J., Fatouros, P.P., and Young, H.F. (1988) Production and clearance of lactate from brain tissue, cerebrospinal fluid, and serum following experimental brain injury. Journal of Neurosurgery, 69, 736-744. 

Histidinemia results from deficiency of histidine ammonia-lyase. With a normal diet, histidine (and the products imidazole-pyruvate, imidazole-lactate, imidazole-acetate) accumulates in plasma, cerebrospinal fluid, and urine. This rare autosomal recessive disease may be benign or may manifest with mental retardation and speech defects. 

In theory, sodium bicarbonate administration provides fluid and electrolyte replacement and increases arterial pH, thereby improving cardiac function, perfusion and oxygenation of peripheral tissues, and intracellular pH, and should therefore decrease lactate production and increase clearance. However, sodium bicarbonate administration can actually have an adverse effect on intracellular pH. When bicarbonate is given by IV infusion, the carbon dioxide generated diffuses more readily than bicarbonate across cellmembranes and into cerebrospinal fluid. Therefore the intracellular pH can actually be decreased by administration of bicarbonate." ... 

Accumulation of compounds related to the mitochondrial pathway can be detected in one or more body fluids of most patients [1, 2, 15]. Special attention has to be paid to the lactate concentration. Excess of lactate and alanine will be produced after reduction or transamination of accumulated pyruvate (see Fig. 27.1). If there is a severe block in the pyruvate oxidation pathway, and the produced lactate can not adequately be removed by peripheral tissues, it accumulates in blood, urine and/or cerebrospinal fluid, dependent upon the affected tissue(s). A decreased activity of the respiratory chain will shift the equilibrium of the lactate dehydrogenase reaction to conversion of pyruvate to lactate (see also Sect. 1). Thus, patients with a respiratory chain defect should demonstrate an increased lactate/pyruvate ratio in blood, whereas pyruvate dehydrogenase deficiency should result in a normal lactate/pyruvate ratio. However, this tool for differential diagnosis is not helpful in all cases. Furthermore, some patients do not accumulate lactate in blood or urine. 

The most widely known metabolic disorders are those which result in impairment of the intermediary metabolism of nutrients such as proteins, carbohydrates and lipids. For example, phenylketonuria is due to a genetic deficiency of phenylalanine hydroxylase, an enzyme involved in the conversion of phenylalanine to tyrosine. As a result, when ingested in amounts normally encountered in the diet, phenylalanine accumulates in blood and cerebrospinal fluid along with its pyruvate, lactate and acetate derivatives. (See review by McBean and Stephenson. ) The toxic response takes the form of severe mental retardation, neural and dermal lesions and premature death. But phenylalanine is an essential dietary amino acid and cannot be rigorously excluded from the diet, even of sufferers from phenylketonuria, though fortunately they do respond to reduced dietary intakes. Clearly, phenylalanine hydroxylase deficiency narrows the gap between the required intake and that which elicits a toxic response because this pathway is more readily overloaded . 

Yoshida, T., Tada, K. and Arakawa, T. (1970), Abnormally high levels of lactate and pyruvate in cerebrospinal fluid of hyperalaninemia with hyperpyruvicemia. Tohoku J. Exp. Med., 101,375. 

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