Glucose and lactate metabolism in experimental septic shock

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Abstract
Effect of an intra-arterial injection of approximately 1010 live Escherichia coli on glucose and lactate metabolism were investigated in the guinea pig. Glucose and lactate kinetics and oxidation were measured in conscious, unrestrained animals by means of the primed constant simultaneous infusion of either [6-3H]- and [U-14C]glucose or [U-14C]lactate. The ability of livers from septic animals to produce glucose from lactate was also examined in isolated perfused livers taken from animals at 3 and 15 h post E. coli and compared to glucose production in livers taken from control animals. In vivo, there was a sustained increase in glucose production over the first 6 h post E. coli, and hyperglycemia was evident. In contrast, the in vitro capacity for glucose production was significantly impaired at 3 h post E. coli. At 14 h, glucose production was not depressed in vivo below the control value, but, hypoglycemia was evident. The in vitro gluconeogenic capacity was reduced at 15 h. Factors were operative in vivo that enabled glucose production to remain at the control level or above despite a direct inhibitory effect of E. coli on glucose production evident in the isolated liver. An increased rate of recycling of glucose carbons (as lactate) back to the liver for reincorporation into glucose, rather than being directed to CO2, appeared to be a factor.

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