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Test Code DLAC D-Lactate, Plasma

Performing Laboratory

Mayo Medical Laboratories in Rochester

Reporting Name

D-Lactate, P

Specimen Type

Plasma NaFl-KOx


Necessary Information


For L-lactate (lactic acid), order LAA / Lactate, Plasma



Specimen Required


Collection Container/Tube: Grey top (potassium oxalate/sodium fluoride) (T275)

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL

Collection Instructions: Spin down and immediately freeze specimen.

Additional Information: For L-lactate (lactic acid), order LLA / Lactate, Plasma.


Reject Due To

Hemolysis

Mild OK; Gross OK

Lipemia

Mild OK; Gross OK

Icterus

Mild OK; Gross OK

Other

NA

Specimen Stability Information

Specimen Type Temperature Time
Plasma NaFl-KOx Frozen (preferred) 365 days
  Ambient  7 days
  Refrigerated  7 days

Specimen Minimum Volume

0.55 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

An adjunct to urine D-lactate (preferred), in the diagnosis of D-lactate acidosis

Testing Algorithm

DLAU / D-Lactate, Urine is the preferred specimen for D-lactate determinations.

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
DLAC D-Lactate, P 14045-9

 

Result ID Test Result Name Result LOINC Value
8878 D-Lactate, P 14045-9

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 of D-lactate are present, individuals can experience metabolic acidosis, altered mental status (from drowsiness to coma), and a variety of other neurologic symptoms, particularly dysarthria and ataxia.

 

D-lactic acidosis is typically observed in patients with a malabsorptive disorder, such as short-bowel syndrome, or, following a jejunoileal bypass. 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, DLAU / D-Lactate, Urine is the preferred specimen for D-lactate determinations.

Interpretation

Increased levels are consistent with D-lactic acidosis. However, because D-lactate is readily excreted, urine determinations are preferred.

Cautions

Urine is the preferred specimen to determine D-lactate.

 

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 Biochem1980;102(1):39-46

2. Petersen C: D-lactic acidosis. Nutr Clin Pract 2005;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.(Oh MS, Phelps KR, Traube M, et al: D-Lactic acidosis in a man with the short-bowel syndrome. N Engl J Med 1979;301:249-252; Dahlquist NR, Perrault J, Callaway CW, Jones JD: D-Lactic acidosis and encephalopathy after jejunoileostomy: response to overfeeding and to fasting in humans. Mayo Clin Proc 1984;59:141-145)