Neurocardiac toxicity of racemic d,l-lactate fluids

Lawrence Chan, Johnathan Slater, James Hasbargen, David Herndon, Richard L. Veech, Stewart Wolf

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Racemic d,l-lactate has long been used in burn therapy as Ringer's lactate and in peritoneal dialysis fluid for treatment of renal failure. The d-lactate component of this racemic mixture is known to cause two forms of neurological toxicity in patients: encephalopathy and, in a subset of the population, panic reaction. Here we demonstrate that coma, similar in degree to that produced by blood levels of 75 mM ethanol was induced in rats by the intraperitoneal infusion of sodium d-lactate sufficient to raise serum d-lactate concentration to 25 mM, whereas infusion of equal quantities of sodium l-lactate produced no observable neurological effect. We further demonstrate that the intravenous infusion of racemic d,l-lactic acid into 48-hour fasted rats produced serious disturbances of cardiac rate and rhythm leading to death. When serum d-lactate concentration had reached 1-2 mM there was bradycardia, at 2-3 mM prolongation of QT interval, at 6-7 mM AV block with ectopic escape rhythms, and at 11 mM death in ventricular standstill or fibrillation. In contrast, intravenous infusion of l-lactic acid to blood levels of 25 mM failed to produce any change in cardiac rhythm. On the other hand, the isolated working heart, free of influence from the central nervous system, displayed no change of cardiac rhythm or physiological function when perfused with 25 mM sodium d,l-lactate.

Original languageEnglish (US)
Pages (from-to)383-394
Number of pages12
JournalIntegrative Physiological and Behavioral Science
Volume29
Issue number4
DOIs
StatePublished - Oct 1994

Fingerprint

Lactic Acid
Sodium Lactate
Intravenous Infusions
Parenteral Infusions
Panic
Atrioventricular Block
Ascitic Fluid
Brain Diseases
Peritoneal Dialysis
Bradycardia
Coma
Treatment Failure
Serum
Renal Insufficiency
Ethanol
Central Nervous System
Sodium
Population

Keywords

  • arrhythmia
  • d,l-lactate
  • encephalopathy
  • panic reaction

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Neuroscience(all)
  • Behavioral Neuroscience

Cite this

Chan, L., Slater, J., Hasbargen, J., Herndon, D., Veech, R. L., & Wolf, S. (1994). Neurocardiac toxicity of racemic d,l-lactate fluids. Integrative Physiological and Behavioral Science, 29(4), 383-394. https://doi.org/10.1007/BF02691358

Neurocardiac toxicity of racemic d,l-lactate fluids. / Chan, Lawrence; Slater, Johnathan; Hasbargen, James; Herndon, David; Veech, Richard L.; Wolf, Stewart.

In: Integrative Physiological and Behavioral Science, Vol. 29, No. 4, 10.1994, p. 383-394.

Research output: Contribution to journalArticle

Chan, L, Slater, J, Hasbargen, J, Herndon, D, Veech, RL & Wolf, S 1994, 'Neurocardiac toxicity of racemic d,l-lactate fluids', Integrative Physiological and Behavioral Science, vol. 29, no. 4, pp. 383-394. https://doi.org/10.1007/BF02691358
Chan, Lawrence ; Slater, Johnathan ; Hasbargen, James ; Herndon, David ; Veech, Richard L. ; Wolf, Stewart. / Neurocardiac toxicity of racemic d,l-lactate fluids. In: Integrative Physiological and Behavioral Science. 1994 ; Vol. 29, No. 4. pp. 383-394.
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