Automated assay for plasma D-lactate by enzymatic spectrophotometric analysis with sample blank correction

Ann Clin Biochem 2008;45:177-183
© 2008 Association for Clinical Biochemistry


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Original Article

Daniel Juan Herrera 1 ,
Kevin Morris 2,
Chris Johnston 1 and
Paul Griffiths 1

1 Department of Clinical Chemistry;
2 Intensive Care Unit, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK

Corresponding author: Daniel Juan Herrera. Email: daniel.herrera{at}

Background: D-lactate is essentially a product of bacterial metabolism,and its assessment in plasma has been mainly used to diagnoseD-lactic acidosis in patients with short bowel syndrome. Inthe last few years, there has been growing interest in the useof subclinical elevations of D-lactate concentrations as a diagnostictool in a variety of clinical conditions such as ischaemia,trauma or infection.

Methods: An endpoint enzymatic spectrophotometric assay to measure plasmaD-lactate with a sample blank correction was validated on ourroutine clinical chemistry analyser (Olympus AU640). An ultrafiltrationprocedure was used in samples with a high L-lactate dehydrogenase(L-LDH) activity in order to avoid underestimation of the D-lactateconcentration, when a sample blank was processed.

Results: The intra- and inter-assay imprecision were <5.1% and <13.3%, respectively and the mean recovery for the D-lactate assay was 95% (range 88–103%). Samples with L-LDH activity greater than 1500 IU/L required the use of ultrafiltration devices. Plasma D-lactate concentration in our ‘non-diseased’ paediatric population showed a non-Gaussian distribution – 95th percentile equal to 19 µmol/L – and no differencebased on gender or age was observed.

Conclusion: We have established an accurate, sensitive and precise routineassay for D-lactate measurement in plasma. The assay was usedto formulate paediatric reference ranges and will be used toassist clinicians to evaluate ‘D-lactate toxicity’in patients with a variety of conditions such as short bowelsyndrome, small bowel transplantation and as an early markerof intestinal ischaemia.

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