Intended for healthcare professionals

Rapid response to:

Endgames Case Report

Life threatening lactic acidosis

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c857 (Published 25 March 2010) Cite this as: BMJ 2010;340:c857

Rapid Response:

D-lactate in diabetic ketoacidosis

Dear Editor,

This well conducted case study demonstrates clearly the role of
lactic acid. A significant part of the lactate load is due to D-lactic
acid enantiomer (1). It is the end product of the glyoxalase system that
metabolises methylglyoxal, a major intracellular glucose metabolite.

Use of biguanides is also associated with a reduced oxygen
consumption (2) which adds to the propensity of acidosis.

D-lactate is metabolised by a high Km mitochondrial D-lactate
oxidase. Therefore, its clearance is much slower than that of the L-
enantiomer.

D-lactate can be analysed with a low-cost technique in blood and
urine (3).

1 Christopher MM, Broussard JD, Fallin CW, et al. Increased serum D-
lactate associated with diabetic ketoacidosis. Metabolism 1995; 44: 287

2 Protti, A, Russo, R, Tagliabue P et al. Oxygen consumption is
depressed in patients with lactic acidosis due to biguanide intoxication.
Crit care 2010; 14: R22

3 Talasniemi JP, Pennanen S, Savolainen H, et al. Assay of D-lactate
in diabetic plasma and urine. Clin Biochem 2008; 41: 1099

Competing interests:
None declared

Competing interests: No competing interests

26 March 2010
Heikki Savolainen
Prof.
Dept. of Occup. Safety & Hlth., FIN-33101 Tampere, Finland