oru.sePublikationer
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Complications but not obesity or diabetes mellitus have impact on the intraperitoneal lactate/pyruvate ratio measured by microdialysis
Örebro University, School of Health and Medical Sciences.
Örebro University, School of Health and Medical Sciences.
2010 (English)In: Scandinavian Journal of Gastroenterology, ISSN 1502-7708, Vol. 45, no 1, 115-121 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Studies have shown a higher risk of postoperative complications in diabetic and obese patients. An increased intraperitoneal lactate/pyruvate ratio as measured by microdialysis has been reported before postoperative complications have been discovered. It is not known whether diabetes or obesity have any influence on the intraperitoneal metabolism (lactate/pyruvate ratio, glucose, glycerol) in relation to major abdominal surgery. The aim of this study was to investigate the postoperative intraperitoneal and subcutaneous carbohydrate and fat metabolism as measured by microdialysis in obese and diabetic patients after major abdominal surgery without postoperative complications.

Material and methods: Seven obese patients (body mass index > 30 kg/m(2)) and six diabetic but non-obese patients were studied up to 48 h after major abdominal surgery and were compared with 31 non-diabetic, non-obese patients, all without complications. Microdialysis was performed to measure glucose, lactate, pyruvate and glycerol intraperitoneally and subcutaneously. The lactate/pyruvate ratio was calculated.

Results: The lactate/pyruvate ratio did not differ between the groups. In the diabetic patients, glucose levels were higher intraperitoneally at both Days 1 and 2 compared to controls. Higher glycerol levels were found subcutaneously in obese patients at Day 2. CONCLUSIONS: The lactate/pyruvate ratio does not increase intraperitoneally after non-complicated major abdominal surgery in diabetic and obese patients. Obese patients have increased release of free fatty acids and glycerol subcutaneously, while diabetic patients show higher glucose levels intraperitoneally than controls.

Place, publisher, year, edition, pages
2010. Vol. 45, no 1, 115-121 p.
Keyword [en]
Diabetes, glucose, glycerol, intraperitoneal microdialysis, lactate/pyruvate ratio, obesity
National Category
Gastroenterology and Hepatology Medical and Health Sciences Surgery
Research subject
Medicine; Surgery
Identifiers
URN: urn:nbn:se:oru:diva-11986DOI: 10.3109/00365520903386713PubMedID: 19961346OAI: oai:DiVA.org:oru-11986DiVA: diva2:354625
Available from: 2010-10-04 Created: 2010-10-04 Last updated: 2017-10-18Bibliographically approved
In thesis
1. Early detection of major surgical postoperative complications evaluated by microdialysis
Open this publication in new window or tab >>Early detection of major surgical postoperative complications evaluated by microdialysis
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Major abdominal surgery may be followed by postoperative complications, especially in the elderly and patients with co morbidities as diabetes mellitus and obesity. Some of the most feared complications as anastomotic leakage, abdominal infections, abdominal compartment syndrome (ACS) and intestinal ischemia can lead to sepsis, systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) with high morbidity and mortality. This thesis evaluates intraperitoneal microdialysis (IPM) as a method for early detection of surgical complications. IPM measures extracellular metabolites as lactate, pyruvate, glycerol and glucose. The lactate/pyruvate (l/p) ratio describes the current relationship between aerobic and anaerobic metabolism. Glycerol is a degradation product of lipolysis from fat and a part of the cell membrane and released when cell injury occurs. In Paper I, evaluation of IPM in patients with and without diabetes mellitus and obesity during 48 hours after abdominal surgery did not show any difference in l/p ratio and glycerol levels compared to a control group. Paper II investigated the first two days after abdominal surgery in patients with major complications using IPM. L/p ratio was higher and glycerol was lower. Paper III used IPM in the immediate postoperative period in patients after endovascular repair for ruptured abdominal aortic aneurysm (rEVAR). Patients who required decompression due to intraabdominal hypertension (IAH) with organ failure had higher l/p ratio and glycerol. Paper IV investigated the effects of Aortic Balloon Occlusion (ABO) and Superior Mesenteric Artery (SMA) occlusion for one hour followed by three hours reperfusion in an animal model. ABO had a pronounced effect on the hemodynamic state. I.p l/p ratio increased during ischemia and decreased on reperfusion while glycerol increased on reperfusion and the effect was less pronounced in the SMA group. In conclusion, IPM monitoring of l/p ratio and glycerol indicates serious postoperative complications at an early stage. The l/p ratio increases or is continuously high while glycerol seems to have a more complex pattern. Diabetes and obesity do not influence the results.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2013. 64 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 89
Keyword
aortic occlusion balloon, anastomotic leakage, glycerol, intraabdominal hypertension, intraperitoneal microdialysis, intestinal ischemia, intraabdominal metabolism, lactate/pyruvate ratio, postoperative complications, ruptured abdominal aortic anerusym
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-28662 (URN)978-91-7668-939-4 (ISBN)
Public defence
2013-06-07, Wilandersalen, Universitetssjukhuset, Södra Grev Rosengatan 18, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-04-11 Created: 2013-04-11 Last updated: 2017-10-18Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Authority records BETA

Hörer, TalNorgren, Lars

Search in DiVA

By author/editor
Hörer, TalNorgren, LarsJansson, Kjell
By organisation
School of Health and Medical Sciences
Gastroenterology and HepatologyMedical and Health SciencesSurgery

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 53 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf