Re: lactate/pyruvate interpretation

[Guest guest]

I just realized the L stands for " low, " so nevermind on the units

confusion question. Comments as to the interpretation of low pyruvate

will still be appreciated. Thanks.

>

>

> I just got results back from a lactate/pyruvate test my neurologist

> ran. Lactic acid reference range was 0.4-2.0 mmol/L, and my level

> appears normal at 0.7. The reference range for pyruvate is listed as

> 0.30-0.70 mg/dL, and my level is listed as 0.03 L. I don't understand

> why the units for the reference range (mg/dL) appear different from

the

> units for my reading (L). Should I ignore that? If so, does that mean

> that I have very low pyruvate? If so, can anybody help interpret the

> results? (My primary care doc's out of town, and my neurologist

> strangely told me the results were fine before they even came back

yet,

> so I was hoping to get some thoughts from this forum). Thanks!

[Guest guest]

RH

At my local hospital I can get copies of lab results before or after

they go to the doc. I just have to show my drivers license and sign a

request form. I always pick up the results of the previous tests when

I go for new ones or before a doctor's appointment. This way I don't

loose track of which ones I have and have a copy in my notebooks.

I'm thinking it is local policy of each lab or hospital.

laurie

>

>

> I'm not a doctor of course, just my experience. The message is that

> doctors seem to have different opinions on lactate and pyruvate. I

> agree that interpretation of lab results is the doctor's realm, but

> it is frustrating to wait.

>

> Did they release the results to you without telling you if they were

> abnormal or normal? My understanding is that common practice is to

> not release results until they are interpreted by the doctor. It is

> possible your neuro had the results online as preliminary results, so

> knew they were " okay " in their mind, but couldn't release the

> paperwork to you.

>

> Take care,

> RH

>

>

>

>

> > >

> > >

> > > I just got results back from a lactate/pyruvate test my

> neurologist

> > > ran. Lactic acid reference range was 0.4-2.0 mmol/L, and my level

> > > appears normal at 0.7. The reference range for pyruvate is listed

> as

> > > 0.30-0.70 mg/dL, and my level is listed as 0.03 L. I don't

> understand

> > > why the units for the reference range (mg/dL) appear different

> from

> > the

> > > units for my reading (L). Should I ignore that? If so, does that

> mean

> > > that I have very low pyruvate? If so, can anybody help interpret

> the

> > > results? (My primary care doc's out of town, and my neurologist

> > > strangely told me the results were fine before they even came

> back

> > yet,

> > > so I was hoping to get some thoughts from this forum). Thanks!

>

>

>

>

>

>

> Medical advice, information, opinions, data and statements contained herein

> are not necessarily those of the list moderators. The author of this e mail

> is entirely responsible for its content. List members are reminded of their

> responsibility to evaluate the content of the postings and consult with

> their physicians regarding changes in their own treatment.

>

> Personal attacks are not permitted on the list and anyone who sends one is

> automatically moderated or removed depending on the severity of the attack.

>

>

[Guest guest]

It could be a state law in NJ and PA - they seem very worried about

people getting their own medical info easily. Needless to say, I've

been to MANY doctors in NJ and some in PA, and they all seem to not

release results unless the doctor has reviewed them. YMMV I guess.

Take care,

RH

> > > >

> > > >

> > > > I just got results back from a lactate/pyruvate test my

> > neurologist

> > > > ran. Lactic acid reference range was 0.4-2.0 mmol/L, and my

level

> > > > appears normal at 0.7. The reference range for pyruvate is

listed

> > as

> > > > 0.30-0.70 mg/dL, and my level is listed as 0.03 L. I don't

> > understand

> > > > why the units for the reference range (mg/dL) appear

different

> > from

> > > the

> > > > units for my reading (L). Should I ignore that? If so, does

that

> > mean

> > > > that I have very low pyruvate? If so, can anybody help

interpret

> > the

> > > > results? (My primary care doc's out of town, and my

neurologist

> > > > strangely told me the results were fine before they even came

> > back

> > > yet,

> > > > so I was hoping to get some thoughts from this forum). Thanks!

> >

> >

> >

> >

> >

> >

> > Medical advice, information, opinions, data and statements

contained herein

> > are not necessarily those of the list moderators. The author of

this e mail

> > is entirely responsible for its content. List members are

reminded of their

> > responsibility to evaluate the content of the postings and

consult with

> > their physicians regarding changes in their own treatment.

> >

> > Personal attacks are not permitted on the list and anyone who

sends one is

> > automatically moderated or removed depending on the severity of

the attack.

> >

> >

[Guest guest]

As I said in a previous post, I've found medical professionals

disagree on what if anything low pyruvate means. Certainly it seems

that many of us don't have low pyruvate and some have high pyruvate -

low pyruvate doesn't seem to be a shared test result. I wish we

could be of more help.

For reference, 0.03 is in the same range I test at. I am relatively

asymptomatic compare to others in this group, I believe; problems are

mostly intermittent weakness, stroke-like and seizure-like episodes.

I have a definitive dx of mitochondrial disease by fresh muscle

biopsy.

Maybe this info will help you:

http://www.mdausa.org/experts/question.cfm?id=2104

and I'd recommend checking out www.umdf.org and browsing their site.

Take care,

RH

> >

> >

> > I just got results back from a lactate/pyruvate test my

neurologist

> > ran. Lactic acid reference range was 0.4-2.0 mmol/L, and my level

> > appears normal at 0.7. The reference range for pyruvate is listed

as

> > 0.30-0.70 mg/dL, and my level is listed as 0.03 L. I don't

understand

> > why the units for the reference range (mg/dL) appear different

from

> the

> > units for my reading (L). Should I ignore that? If so, does that

mean

> > that I have very low pyruvate? If so, can anybody help interpret

the

> > results? (My primary care doc's out of town, and my neurologist

> > strangely told me the results were fine before they even came

back

> yet,

> > so I was hoping to get some thoughts from this forum). Thanks!

[Guest guest]

I'll have a doctorate in chemistry soon I hope

My MDA doctor, who sees a good amount of mito patients, says the

ratio is important. My understanding, although I did not ask him

directly, is that Dr. Shoffner thinks it is important. That is, at

the time I saw him, I hadn't had a high lactate value, only high L/P

ratios.

Here are some links to articles on lactate/pyruvate ratio, not all

mito-related:

http://ccforum.com/content/9/S1/P415

http://www.endocrinesurgeon.co.uk/atoz/ischaemic%20lactate.html

http://www.mdausa.org/experts/question.cfm?id=3218

(did I send a link to that already?)

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?

cmd=Retrieve&db=PubMed&list_uids=8147937&dopt=Abstract

http://www.ukfibromyalgia.com/nutrition/emds.html

http://pediatricneuro.com/alfonso/pg81.htm

http://www.neuro.wustl.edu/neuromuscular/mitosyn.html

, specifically the following:

> Lactate & Pyruvate

> Source: Arterial better than venous

> CSF may be abnormal when blood normal

> Usually elevated in children

> Lactate/Pyruvate ratio

> High (> 50:1): Suggests metabolic block in respiratory chain

> Normal: Metabolic block is upstream, e.g. Pyruvate dehydrogenase

> complex

> High lactate at rest in PEO

> Rare with pure CPEO

> Common (80%) with A3243G and A8344G mutations

> Suggests fatigue is likely

> Normal values do not exclude mitochondrial disorders

> Examples: NARP; MILS

The difficult part is to find things that reference normal or low

lactate, but high lactate/pyruvate ratio.

Here is one article that does mention it:

http://adc.bmjjournals.com/cgi/content/full/76/1/16

> ...However, the L/C ratio was very beneficial in some instances.

Three patients (numbers 10, 13, and 14) had a renal disorder with a

low level of tubular lactate reabsorption that could lead to normal

lactate and high L/C ratios. Two patients (numbers 20 and 27), with

no apparent kidney disorder, had L/C ratios above the 90th centile

when their lactate was normal. Furthermore, measurement of L/C ratios

is not prone to false positive results due to difficulties in blood

sampling and deproteinisation. The usefulness of L/P ratios is

obvious in the differential diagnosis of hyperlactataemia due to

pyruvate dehydrogenase complex deficiency.

Take care,

RH

>

> RH thanks for your clarification of the lactate/pyruvate ratio. I

> have been trying to find information on it since I got my test

results

> back. I asked Dr. Enns about the ratio, but I guess he is one that

> doesn't believe that it makes a difference. All he told me is that

> all my tests were normal. Which I don't understand since my

pyruvate

> level is very low. According to the formula you gave. My test

results

> are: 1.2/0.01 = 120. That is definately WAY over 20. But my lactic

> acid is within normal range. Do you know of any papers that have

been

> written on this? My citiric acid levels were also low. I did some

> research on this and found out that " low citric acid may be due to

> impaired function of the Krebs cycle which is also indicated by

> extremely high succinic acid. " You about need a doctorate in

chemistry

> to figure this all out.

>

> Thanks

> Joanne

[Guest guest]

FYI, L/C is the lactate/creatinine ratio. Here's the blurb on L/P

(lactate/pyruvate ratio):

>The L/P ratio was a sensitive variable in our series of patients

with RCD. It was always abnormal when blood lactate was above 2.5

mmol/l and two patients (numbers 24 and 27) showed high L/P ratios

concomitantly with normal lactataemia.

Sorry for the confusion.

Take care,

RH

> >

> > RH thanks for your clarification of the lactate/pyruvate ratio.

I

> > have been trying to find information on it since I got my test

> results

> > back. I asked Dr. Enns about the ratio, but I guess he is one

that

> > doesn't believe that it makes a difference. All he told me is

that

> > all my tests were normal. Which I don't understand since my

> pyruvate

> > level is very low. According to the formula you gave. My test

> results

> > are: 1.2/0.01 = 120. That is definately WAY over 20. But my

lactic

> > acid is within normal range. Do you know of any papers that have

> been

> > written on this? My citiric acid levels were also low. I did

some

> > research on this and found out that " low citric acid may be due

to

> > impaired function of the Krebs cycle which is also indicated by

> > extremely high succinic acid. " You about need a doctorate in

> chemistry

> > to figure this all out.

> >

> > Thanks

> > Joanne