An adjunct to urine D-lactate (preferred) for the diagnosis of D-lactate acidosis
Enzymatic
Lactate (D), Plasma
Plasma NaFl-KOx
Urine is the preferred specimen for D-lactate determination, order DLAU / D-Lactate, Urine.
For determination of L-lactate (lactic acid), order LACS1 / Lactate, Plasma
Collection Container/Tube: Sodium Fluoride/Potassium Oxalate Tube, 2 mL (T275)
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions: Centrifuge, aliquot plasma into plastic vial, and freeze immediately.
0.55 mL
Gross hemolysis | OK |
Gross lipemia | OK |
Gross icterus | OK |
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Plasma NaFl-KOx | Frozen (preferred) | 365 days | |
Ambient | 7 days | ||
Refrigerated | 7 days |
An adjunct to urine D-lactate (preferred) for the diagnosis of D-lactate acidosis
D-lactate is produced by bacteria residing in the colon when carbohydrates are not completely absorbed in the small intestine. When large amounts of D-lactate are present, individuals can experience metabolic acidosis, altered mental status (from drowsiness to coma), and a variety of other neurologic symptoms, in particular dysarthria and ataxia. Although a temporal relationship has been described between elevations of plasma and urine D-lactate and the accompanying encephalopathy, the mechanism of neurologic manifestations has not been elucidated.
D-lactic acidosis is typically observed in patients with a malabsorptive disorder, such as short-bowel syndrome, or following a jejunoileal bypass. In addition, healthy children presenting with gastroenteritis may also develop the clinical presentation of D-lactic acidosis.
Routine lactic acid determinations in blood will not reveal abnormalities because most lactic acid assays measure only L-lactate. Accordingly, D-lactate analysis must be specifically requested (eg, this test). However, as D-lactate is readily excreted in urine, it is the preferred specimen for D-lactate determinations; see DLAU / D-Lactate, Urine.
0.0-0.25 mmol/L
Increased levels are consistent with D-lactic acidosis. However, because D-lactate is readily excreted, urine determinations are preferred.
The test performed was D-lactate. This is a product of bacterial overgrowth in the gastrointestinal tract. It should not be confused with L-lactate, which accumulates in some metabolic acidosis.
1. Petersen C: D-lactic acidosis. Nutr Clin Pract. 2005;20(6):634-645
2. Kowlgi NG, Chhabra L: D-Lactic acidosis: An underrecognized complication of short bowel syndrome. Gastroenterol Res Pract. 2015;2015:476215. doi: /10.1155/2015/476215
D-lactate is oxidized to pyruvate in the presence of D-lactate dehydrogenase and nicotinamide adenine dinucleotide (NAD+). The reaction proceeds because the pyruvate is continually removed as a pyruvate-hydrazone complex. The quantity of NADH produced is directly proportional to the amount of D-lactate oxidized and is measured spectrophotometrically at 340 nm.(Brandt RB, Siegel SA, Waters MG, Bloch MH: Spectrophotometric assay for D-(-)-lactate in plasma. Anal Biochem.1980;102(1):39-46; Cowan T, Pasquali M: Laboratory investigations of inborn errors of metabolism. In: K Sarafoglou, GF Hoffman, KS Roth, eds. Pediatric Endocrinology and Inborn Errors of Metabolism. 2nd ed. McGraw-Hill Education; 2017:1139-1158)
Wednesday, Friday
This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.
83605
Test Id | Test Order Name | Order LOINC Value |
---|---|---|
DLAC | D-Lactate, P | 14045-9 |
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.
|
---|---|---|
8878 | D-Lactate, P | 14045-9 |