Test Id : LAPYP
Lactate Pyruvate Panel, Plasma
Useful For
Suggests clinical disorders or settings where the test may be helpful
Diagnosing and monitoring patients with lactic acidosis
Monitoring lactate-to-pyruvate ratios
Highlights
This test provides results for both lactate and pyruvate on a single collection
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
For more information see Epilepsy: Unexplained Refractory and/or Familial Testing Algorithm
Method Name
A short description of the method used to perform the test
Gas Chromatography Mass Spectrometry (GC-MS)
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
Lactate
Lactic acid
Pyruvate
Pyruvic acid
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
For more information see Epilepsy: Unexplained Refractory and/or Familial Testing Algorithm
Specimen Type
Describes the specimen type validated for testing
Plasma
Ordering Guidance
This test does not measure D-lactate, an uncommon, often undiagnosed cause of lactic acidosis. If D-lactate testing is needed, order DLAU / D-Lactate, Urine (preferred) or DLAC / D-Lactate, Plasma.
Analytes from this test are included in test MMPP / Mitochondrial Metabolites, Plasma. If ordered together, this test may be canceled.
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Collection Container/Tube:
Preferred: Green top (Sodium heparin)
Acceptable: Green top (Lithium heparin)
Submission Container/Tube: Plastic vial
Specimen Volume: 0.5 mL
Collection Instructions: Centrifuge and aliquot plasma into a plastic vial.
Special Instructions
Library of PDFs including pertinent information and forms related to the test
Forms
If not ordering electronically, complete, print, and send a Biochemical Genetics Test Request (T798) with the specimen.
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
0.1 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Gross hemolysis | Reject |
| Gross lipemia | OK |
| Gross icterus | OK |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Plasma | Frozen (preferred) | 90 days | |
| Ambient | 7 days | ||
| Refrigerated | 7 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Diagnosing and monitoring patients with lactic acidosis
Monitoring lactate-to-pyruvate ratios
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
For more information see Epilepsy: Unexplained Refractory and/or Familial Testing Algorithm
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Lactic acid (lactate) is primarily produced from glucose metabolism via the glycolytic pathway. Although primarily metabolized by the liver, other tissues also use small amounts of lactate. Typically, the amount of lactate produced parallels the amount utilized. Both the rates of lactate production and liver clearance impact the lactate concentration in blood. Lactic acidosis, or the accumulation of excess lactate, results from a combination of increased lactate production with decreased utilization.
Patients experiencing lactic acidosis present with tachypnea, weakness, and fatigue. Untreated, patients may develop confusion and progress to coma. Lactic acidosis may be associated with hypoxic conditions (eg, shock, hypovolemia, heart failure, pulmonary insufficiency), metabolic disorders (eg, diabetic ketoacidosis, malignancies, inborn errors of metabolism), and toxin exposures (eg, ethanol, methanol, salicylates).
Pyruvic acid, an intermediate metabolite, plays an important role in linking carbohydrate and amino acid metabolism to the tricarboxylic acid cycle, the fatty acid beta-oxidation pathway, and the mitochondrial respiratory chain complex. However, pyruvic acid levels alone have little clinical utility.
Combined analysis of lactate and pyruvate may suggest an inborn error of metabolism when elevations of both analytes are observed or when there is an abnormal lactate-to-pyruvate (L:P) ratio. For example, several mitochondrial respiratory chain disorders exhibit elevated L:P ratios. Mitochondrial disorders vary widely in both clinical presentation and age of onset. Patients commonly present with neurologic and myopathic features. In addition, patients may experience involvement of multiple organ systems with features such as myopathy, ophthalmoplegia, ptosis, cardiomyopathy, sensorineural hearing loss, optic atrophy, pigmentary retinopathy, diabetes mellitus, encephalomyopathy, seizures, and stroke-like episodes.
A low L:P ratio is observed in inherited disorders of pyruvate metabolism including pyruvate dehydrogenase complex (PDHC) deficiency. Clinical presentation of PDHC deficiency can range from fatal congenital lactic acidosis to relatively mild ataxia or neuropathy. The most common features observed in infants and children with PDHC deficiency are developmental delay, hypotonia, seizures, and ataxia. Other manifestations may include congenital brain malformations, degenerative changes including Leigh disease, and facial dysmorphism.
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Lactic Acid
< or = 4000.0 nmol/mL
Pyruvic Acid
< or = 350.0 nmol/mL
Interpretation
Provides information to assist in interpretation of the test results
An elevated lactate-to-pyruvate (L:P) ratio may indicate inherited disorders of the respiratory chain complex, tricarboxylic acid cycle disorders, and pyruvate carboxylase deficiency. Respiratory chain defects usually result in L:P ratios above 20.
A low L:P ratio (disproportionately elevated pyruvic acid) may indicate an inherited disorder of pyruvate metabolism. Defects of the pyruvate dehydrogenase complex result in L:P ratios below 10.
The L:P ratio is characteristically normal in other patients. An artifactually high ratio can be found if the patient is acutely ill.
Cerebrospinal fluid (CSF) L:P ratio may assist in evaluation of patients with neurologic dysfunction and normal blood L:P ratios. Blood and CSF specimens should be collected at the same time.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
No significant cautionary statements
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Munnich A, Rotig A, Cormier-Daire V, Rustin P. Clinical presentation of respiratory chain deficiency. In: Valle DL, Antonarakis S, Ballabio A, Beaudet AL, Mitchell GA, eds. The Online Metabolic and Molecular Bases of Inherited Disease. McGraw-Hill; 2019. Accessed July 5, 2024. Available at http://ommbid.mhmedical.com/content.aspx?bookid=2709§ionid=225086827
2. Robinson BH. Lactic acidemia: Disorders of pyruvate carboxylase and pyruvate dehydrogenase. In: Valle DL, Antonarakis S, Ballabio A, Beaudet AL, Mitchell GA, eds. The Online Metabolic and Molecular Bases of Inherited Disease. McGraw-Hill; 2019. Accessed July 5, 2024. Available at http://ommbid.mhmedical.com/content.aspx?bookid=2709§ionid=225087140
3. Shoffner JM. Oxidative phosphorylation diseases. In: Valle DL, Antonarakis S, Ballabio A, Beaudet AL, Mitchell GA, eds. Online Metabolic and Molecular Bases of Inherited Disease. McGraw-Hill; 2019 Accessed July 5, 2024. Available at http://ommbid.mhmedical.com/content.aspx?bookid=2709§ionid=225088339
Method Description
Describes how the test is performed and provides a method-specific reference
A mixture of labeled internal standards is added to patient plasma following oximation of keto acids. The samples are acidified and extracted. After evaporation, the dry residue is silylated analyzed by capillary gas chromatography mass spectrometry using selected ion monitoring with positive electron impact ionization and stable isotope dilution.(Unpublished Mayo method)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Wednesday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
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- Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
- Prospective clients should contact their account representative. For assistance, contact Customer Service.
Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.
CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
83605
84210
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| LAPYP | Lactate Pyruvate Panel, P | 101656-7 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| 616797 | Interpretation | 59462-2 |
| 616794 | Lactic acid | 2524-7 |
| 616795 | Pyruvic acid | 32338-6 |
| 616796 | Reviewed by | 18771-6 |