Department of Pediatric Neurology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
Eur J Pediatr. 2022 Jun;181(6):2227-2235. doi: 10.1007/s00431-022-04446-3. Epub 2022 Mar 18.
Traditionally, clinicians consider lactate as a waste product of anaerobic glycolysis. Interestingly, research has shown that lactate may serve as an alternative fuel for the brain to protect it against harm. The increasing scientific awareness of the potential beneficial side of lactate, however, is entering the clinic rather slowly. Following this, and realizing that the application of potential novel therapeutic strategies in pediatric populations often lags behind the development in adults, this review summarizes the key data on therapeutic use of intravenous infusion of sodium lactate in humans. PubMed and clinicaltrial.gov were searched up until November 2021 focusing on interventional studies in humans. Thirty-four articles were included in this review, with protocols of lactate infusion in adults with diabetes mellitus, traumatic brain injury, Alzheimer's disease, and cardiac disease. One study on lactate infusion in children was also included. Results of our literature search show that sodium lactate can be safely administrated, without major side effects. Additionally, the present literature clearly shows the potential benefits of therapeutic lactate infusion under certain pathological circumstances, including rather common clinical conditions like traumatic brain injury.
This review shows that lactate is a save, alternative energy source for the adult brain warranting studies on the potential therapeutic effects of sodium lactate infusion in children.
• Lactate is generally considered a waste product of anaerobic glycolysis. However, lactate also is an alternative fuel for different organs, including the brain. • Lactate infusion is not incorporated in standard care for any patient population.
• Thirty-four studies investigated the therapeutic use of intravenous sodium lactate in different patient populations, all with different study protocols. • Literature shows that lactate infusion may have beneficial effects in case of hypoglycemia, traumatic brain injury, and cardiac failure without the risk of major side effects.
传统上，临床医生认为乳酸是无氧糖酵解的一种废物产物。有趣的是，研究表明乳酸可能作为大脑的替代燃料，以保护其免受伤害。然而，人们对乳酸潜在有益作用的科学认识不断增加，但进入临床的速度却相当缓慢。鉴于此，并且意识到在儿科人群中应用潜在的新型治疗策略通常落后于成人的发展，本综述总结了静脉输注乳酸钠在人类中的治疗应用的关键数据。检索了 PubMed 和 clinicaltrial.gov，截至 2021 年 11 月，重点关注人类的干预性研究。本综述纳入了 34 篇文章，其中包括糖尿病、创伤性脑损伤、阿尔茨海默病和心脏病患者中乳酸输注的方案。还纳入了一项关于儿童乳酸输注的研究。我们的文献检索结果表明，乳酸钠可以安全给药，没有主要副作用。此外，目前的文献清楚地表明，在某些病理情况下，包括创伤性脑损伤等相当常见的临床情况，治疗性乳酸输注具有潜在益处。
本综述表明，乳酸是成人大脑的一种安全、替代的能源，有必要研究乳酸钠输注在儿童中的潜在治疗效果。
乳酸通常被认为是无氧糖酵解的废物产物。然而，乳酸也是包括大脑在内的不同器官的替代燃料。
乳酸输注未纳入任何患者群体的标准治疗。
34 项研究调查了静脉内输注乳酸钠在不同患者群体中的治疗用途，所有研究都有不同的研究方案。
文献表明，在低血糖、创伤性脑损伤和心力衰竭的情况下，乳酸输注可能具有有益作用，且没有重大副作用的风险。
