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Flashcards in this deck (30)
  • Lactate is produced as a byproduct of which metabolic process?

    Aerobic glucose metabolism

    Anaerobic glucose metabolism (when oxygen is severely diminished)

    Amino acid synthesis

    Fatty acid breakdown

    metabolism lactate
  • What is the normal end product of glycolysis under adequate oxygen conditions?

    Lactate

    Acetyl-CoA

    ATP

    Pyruvate

    glycolysis metabolism
  • Conversion of pyruvate to lactate is triggered by:

    Increased acetyl-CoA formation

    Oxygen deficiency leading to excess NADH accumulation

    High glucose intake

    High levels of NAD⁺ relative to NADH

    metabolism pyruvate
  • How much ATP is generated per mole of glucose metabolized to lactate under hypoxic conditions?

    38 mol

    2 mol

    10 mol

    18 mol

    atp energy
  • Excess blood lactate is clinically important because it indicates:

    High glucose levels

    Adequate tissue oxygenation

    Severity of oxygen deprivation

    Normal metabolic function

    lactate clinical
  • Unlike ions such as K⁺ or Ca²⁺, lactate is not specifically regulated because:

    It is a byproduct of anaerobic metabolism, not a regulated electrolyte

    The kidneys rapidly excrete it

    It is only produced in muscles

    It is stored in bones

    lactate metabolism
  • Blood lactate levels rise and indicate tissue hypoxia:

    Only after pH becomes severely acidic

    Earlier than pH changes

    Later than pH changes

    At the same time as pH changes

    blood hypoxia
  • The major organ responsible for removing lactate from the bloodstream is the:

    Kidneys

    Heart

    Lungs

    Liver

    organ lactate
  • The liver removes lactate by converting it back to glucose through:

    Gluconeogenesis

    The citric acid cycle

    Glycolysis

    Lipolysis

    liver metabolism
  • Blood lactate measurements are NOT used for which of the following?

    Diagnosing vitamin B12 deficiency

    Determining patient prognosis

    Metabolic monitoring of critically ill patients

    Indicating illness severity

    diagnosis lactate
  • Type A lactic acidosis is associated with:

    Toxin exposure

    Metabolic disorders unrelated to oxygen

    Liver disease

    Hypoxic conditions

    acidosis lactate
  • Which of the following is an example of a condition causing Type A lactic acidosis?

    Shock

    Diabetes mellitus

    Salicylate poisoning

    Severe infection

    acidosis shock
  • Type B lactic acidosis has which origin?

    Hypoxic

    Cardiac

    Metabolic

    Respiratory

    acidosis metabolic
  • All of the following are causes of Type B lactic acidosis EXCEPT:

    Myocardial infarction

    Ethanol poisoning

    Renal disease

    Leukemia

    acidosis causes
  • Special specimen handling is required for lactate analysis primarily because:

    Tourniquets have no impact on results

    Hemolysis decreases lactate levels

    It is only stable in urine samples

    Lactate levels can change rapidly after collection due to ongoing metabolism

    specimen lactate
  • Based on Figure 11.8, how many moles of ATP are generated via aerobic metabolism of 1 mole of glucose?

    16 mol

    2 mol

    24 mol

    38 mol

    atp aerobic
  • In anaerobic metabolism, pyruvate is converted to lactate because:

    Oxidative phosphorylation is absent, causing NADH to accumulate

    Oxygen is abundant and drives the reaction

    Glucose breakdown stops at pyruvate

    Acetyl-CoA production is enhanced

    metabolism pyruvate
  • A tourniquet should generally be avoided for lactate sampling because:

    It dilutes the blood sample

    It causes hemolysis of red blood cells

    It inhibits lactate oxidase activity

    Venous stasis increases lactate levels due to local tissue hypoxia

    sampling lactate
  • What should a patient avoid doing before blood collection?

    Sitting for 10 minutes before collection

    Exercising or clenching the hand before/during collection

    Drinking water before collection

    Eating for 2 hours before collection

    blood sample_collection
  • What is the purpose of additives like iodoacetate and fluoride in lactate samples?

    Inhibit glycolysis and prevent glucose-to-lactate conversion

    Increase lactate stability at room temperature

    Enhance clotting

    Preserve red blood cells

    lactate additives
  • Heparinized blood for lactate analysis must be delivered in what manner?

    Left uncentrifuged until testing

    Stored at 37°C for 24 hours

    Mixed with saline before processing

    Delivered on ice and plasma separated quickly to prevent metabolic changes

    lactate blood_handling
  • Which of the following does NOT occur due to hypoxia leading to cell death?

    Intracellular ionic balance is disrupted (increased Ca²⁺/Na⁺; decreased K⁺/Mg²⁺)

    Decreased tissue oxygen supply slows oxidative metabolism

    Pyruvate converts to acetyl-CoA instead of lactate

    NADH accumulates while NAD⁺ levels decline

    hypoxia cell_death
  • Older methods for measuring lactate were considered limited because they were:

    Too sensitive to small changes in lactate levels

    Slow and laborious

    Unable to distinguish between lactate and pyruvate

    Only compatible with urine samples

    lactate measurement
  • Current methods for lactate determination are primarily:

    Colorimetric without enzyme use

    Based on measuring blood flow with indwelling catheters

    Enzymatic and readily available for clinical use

    Pulse oximetry-based

    lactate measurement
  • Which enzyme is most commonly used for lactate measurement?

    Peroxidase

    Lactate dehydrogenase

    Pyruvate kinase

    Lactate oxidase

    lactate enzyme
  • What reaction does lactate oxidase catalyze?

    Lactate + O₂ → pyruvate + H₂O₂

    Pyruvate + H₂O₂ → lactate + O₂

    Lactate + H₂O₂ → pyruvate + O₂

    Pyruvate + O₂ → lactate + H₂O₂

    lactate reaction
  • In the coupled reaction for lactate measurement, peroxidase produces a colored dye from:

    Hydrogen peroxide, an H donor, and chromogen

    Pyruvate, hydrogen peroxide, and an H donor

    Lactate, oxygen, and chromogen

    NADH, NAD⁺, and chromogen

    lactate measurement
  • Which of the following is NOT an alternative method to assess tissue oxygenation besides blood lactate measurements?

    Base-excess determinations

    Indwelling catheters to measure blood flow

    Cholesterol testing

    Pulse oximetry

    tissue_oxygenation methods
  • As hypoxia disrupts intracellular ionic balance, it causes:

    Decreased levels of all cations

    No changes in cation levels

    Decreased Ca²⁺ and Na⁺; increased K⁺ and Mg²⁺

    Increased Ca²⁺ and Na⁺; decreased K⁺ and Mg²⁺

    hypoxia ionic_balance
  • In aerobic metabolism, NADH is oxidized back to NAD⁺ via:

    Gluconeogenesis in the liver

    Anaerobic glycolysis

    Conversion of pyruvate to lactate

    Oxidative phosphorylation in mitochondria

    metabolism nadh
Study Notes

Lactate Production and Metabolism

Overview

Lactate is produced primarily through anaerobic metabolism when oxygen levels are low.

Key Points

  • Anaerobic Glycolysis: Lactate is generated from pyruvate when oxygen is deficient.
  • Glycolysis End Product: Under sufficient oxygen conditions, glycolysis ends in pyruvate.

Importance of Lactate

  • Indicates severity of oxygen deprivation. High lactate often signals tissue hypoxia.
  • Not specifically regulated like ions (K⁺, Ca²⁺) because it is a byproduct of metabolism, not a crucial electrolyte.

Clinical Relevance

  • Blood lactate levels help monitor metabolic status in critically ill patients.
  • Measurement errors can occur due to metabolic changes post-sample collection.

Conversion and Removal

  • The liver converts lactate back to glucose via gluconeogenesis.
  • Renal function is not the primary method for lactate clearance; it is cleared mainly by liver absorption.

Acidosis Types

  • Type A Lactic Acidosis: Due to hypoxic conditions (e.g., shock).
  • Type B Lactic Acidosis: Metabolic origin unrelated to oxygen levels (e.g., renal failure).

Sample Handling for Analysis

  • Avoid using a tourniquet during lactate sampling to prevent hemolysis and venous stasis.
  • Use additives like iodoacetate to inhibit glycolysis and stabilize samples.

Measurement Techniques

  • Current enzymatic methods, especially using lactate oxidase, are preferred for measuring blood lactate.

Lactate Measurement Methodologies

Measurement Techniques

Techniques for Lactate Determination

  • Enzymatic methods are the most common, providing reliable clinical data.

Key Reactions

  • Lactate Oxidase Reaction: Involves converting lactate to pyruvate and producing H₂O₂。
  • Colorimetric Reactions: Use peroxidase to generate a color change from lactate measurement.

Alternative Methods for Assessing Oxygenation

  • Other than lactate levels, pulse oximetry and base-excess determinations can also assess tissue oxygenation.