Gut luminal lactate release during gradual intestinal ischemia

Abstract.

Objectives: Gut ischemia induced by occlusion of the superior mesenteric artery (SMA) results in release of lactate into the gut lumen. We studied the threshold of SMA flow reduction that leads to increased gut luminal lactate during stepwise reduction in SMA blood flow. Design and setting: A randomized, controlled animal experiment in a university experimental research laboratory. Interventions: Anesthetized, normoventilated, normovolemic domestic pigs were randomized to ischemia (n=7) and sham groups (n=7). SMA blood flow was reduced stepwise at 15-min intervals by 22%, 44%, 66%, and 88% and kept constant thereafter for 60 min. Measurements and results: Jejunal luminal microdialysate lactate and mucosal pCO₂ were measured every 15 min. The luminal lactate increased over the upper normal limit of 0.2 mmol/l at a median SMA blood flow of 9.6 ml kg^–1 min^–1 (range 7.5–23.7). In five of seven animals the increase in luminal lactate was preceded by or accompanied by an increase in the mucosal–arterial pCO₂ gradient. Conclusions: There is a threshold of SMA blood flow below which gut luminal lactate increases, indicating mucosal anaerobic metabolism. Measurement of gut luminal lactate by microdialysis can be used to assess the adequacy of gut perfusion and the onset of anaerobic metabolism.