Record C O, Chase R A, Williams R, Appleton D
Metabolism. 1981 Jul;30(7):638-43. doi: 10.1016/0026-0495(81)90076-7.
Six patients with liver damage following paracetamol overdose, one patient with viral hepatitis and six control subjects were infused with sodium L(+) lactate. In controls the results were analysed using a single compartment model while in paracetamol patients a two compartment system was used to derive the fractional rate removal constant and lactate distribution volume. Forearm arterio-venous differences of lactate were also determined in order to assess the role of voluntary muscle in removal of a lactate load. In paracetamol patients with fractional rate removal constant was decreased to less than half the control value (P less than 0.001) while total distribution volume was similar to the two groups. Fasting lactate concentrations were significantly increased in paracetamol patients due to diminished lactate removal since the endogenous production rate of lactate was not significantly different from controls. A greater proportion of the lactate load was removed in voluntary muscle in paracetamol patients (39%) than controls (17%). Since the balance of lactate removal occurs principally in the liver, the decrease in the fractional rate removal constant in patients following paracetamol overdose indicates a severe derangement of hepatic lactate metabolism with a compensatory increase in lactate metabolism in voluntary muscle.
六名对乙酰氨基酚过量导致肝损伤的患者、一名病毒性肝炎患者和六名对照受试者接受了L(+)乳酸钠输注。在对照组中，使用单室模型分析结果，而在对乙酰氨基酚患者中，使用双室系统来推导分数清除率常数和乳酸分布容积。还测定了前臂动静脉乳酸差异，以评估随意肌在清除乳酸负荷中的作用。在对乙酰氨基酚患者中，分数清除率常数降至低于对照组值的一半（P<0.001），而总分布容积在两组中相似。由于乳酸清除减少，对乙酰氨基酚患者的空腹乳酸浓度显著升高，因为乳酸的内源性产生率与对照组无显著差异。对乙酰氨基酚患者中，随意肌清除的乳酸负荷比例（39%）高于对照组（17%）。由于乳酸清除主要发生在肝脏，对乙酰氨基酚过量患者分数清除率常数的降低表明肝脏乳酸代谢严重紊乱，同时随意肌乳酸代谢代偿性增加。
