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Test Code DLAU D-Lactate, Urine

Performing Laboratory

Mayo Medical Laboratories in Rochester

Reporting Name

D-Lactate, U

Specimen Type

Urine


Specimen Required


Container/Tube: Plastic, 10-mL urine tube (T068)

Specimen Volume: 2.5 mL

Collection Instructions:

1. Collect a timed or random urine specimen.

2. No preservative.

3. Immediately freeze specimen.


Reject Due To

Hemolysis

NA

Lipemia

NA

Icterus

NA

Other

NA

Specimen Stability Information

Specimen Type Temperature Time
Urine Frozen (preferred) 365 days
  Refrigerated  7 days
  Ambient  72 hours

Specimen Minimum Volume

0.65 mL

Day(s) and Time(s) Performed

Varies

Specimen Retention Time

1 month

Analytic Time

4 days

Reference Values

0.0-0.25 mmol/L

Useful For

Preferred test for diagnosing D-lactate acidosis, especially in patients with jejunoileal bypass and short-bowel syndrome

Method Name

Enzymatic

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

83605

LOINC Code Information

Test ID Test Order Name Order LOINC Value
DLAU D-Lactate, U 14046-7

 

Result ID Test Result Name Result LOINC Value
8873 D-Lactate, U 14046-7

Clinical Information

D-lactate is produced by bacteria residing in the colon when carbohydrates are not completely absorbed in the small intestine. When large amounts are absorbed it can cause metabolic acidosis, altered mental status (from drowsiness to coma) and a variety of other neurologic symptoms, in particular dysarthria and ataxia. Although a temporal relationship has been described between elevations of plasma and urine D-lactate and the accompanying encephalopathy, the mechanism of neurologic manifestations has not been elucidated.

 

D-lactic acidosis is typically observed in patients with short-bowel syndrome and following jejunoileal bypass resulting in carbohydrate malabsorption. In addition, healthy children presenting with gastroenteritis may also develop the critical presentation of D-lactic acidosis.

 

Routine lactic acid determinations in blood will not reveal abnormalities because most lactic acid assays measure only L-lactate. Accordingly, D-lactate analysis must be specifically requested (eg, DLAC / D-Lactate, Plasma). However, as D-lactate is readily excreted in urine, this is the preferred specimen for D-lactate determinations.

Interpretation

Increased levels are diagnostic.

Cautions

The test performed was D-lactate. This is a product of bacterial overgrowth in the gastrointestinal tract. It should not be confused with L-lactate, which accumulates in some metabolic acidosis.

Clinical Reference

1. Brandt RB, Siegel SA, Waters MG, Bloch MH: Spectrophotometric assay for D-(-)-lactate in plasma. Anal Biochem 1980;102(1):39-46

2. Petersen C: D-lactic acidosis. Nutr Clin Pract 2005 Dec;20(6):634-645

Method Description

D-lactate is oxidized to pyruvate in the presence of D-lactate dehydrogenase and nicotinamide adenine dinucleotide phosphate (NAD). The reaction proceeds because the pyruvate is continually removed as a pyruvate-hydrazone complex. The quantity of reduced NAD produced is directly proportional to the amount of D-lactate oxidized and is measured spectrophotometrically at 340 nm.(Unpublished Mayo method based on Brandt approach[1])

Forms

Biochemical Genetics Patient Information (T602) in Special Instructions.