Metabolic studies of acetoacetate, pyruvate, lactate and citrate in uremic acidosis

• Published in: Clinica chimica acta Vol. 20; no. 2; pp. 341 - 347
• Main Authors: Campanacci, L., Guarnieri, G.F., Siliprandi, N., Fiaschi, E.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.05.1968
• Subjects: Acetoacetates - blood; Acetoacetates - urine; Acidosis - blood; Acidosis - metabolism; Analysis of Variance; Chronic Disease; Citrates - blood; Citric Acid Cycle; Creatine - urine; Female; Glycine - pharmacology; Humans; Kidney Function Tests; Lactates - blood; Male; Models, Biological; Pyruvates - blood; Uremia - blood; Uremia - metabolism
• ISSN: 0009-8981; 1873-3492
• DOI: 10.1016/0009-8981(68)90169-1

Plasma acetoacetate and citrate were measured in a series of 35 patients suffering from chronic uremia. The results showed an increase of acetoacetate and a decrease of citrate in comparison with the values obtained from normal subjects. On the other hand, no significant alterations were observed in both blood pyruvate and lactate in the same uremic patients. In both uremic and normal control subjects, investigation of the 24-h urinary excretion of acetoacetate and of renal function (as determined by creatinine clearance) led to the conclusion that a defective excretory function, per se, cannot account for the increased plasma acetoacetate level. However, it may be suggested that the high acetoacetate and the low citrate levels could be produced through an accumulation of amino compounds, such as amino acids, which undergo massive transamination resulting in the subtraction of some key citric acid cycle intermediates necessary for the optimal utilization of AcCoA. This hypothesis seems to be substantiated by the results obtained following the intravenous injection of glycine in normal subjects. under these circumstances a marked increase of acetoacetate and a decrease of citrate was observed in the plasma.