INCREASED LACTATE PYRUVATE RATIO WITH NORMAL BETA-HYDROXYBUTYRATE/ACETOACETATE RATIO AND LACK OF OXYGEN-SUPPLY DEPENDENCY IN A PATIENT WITHFATAL SEPTIC SHOCK/

We report a case of fatal septic shock, with hyperlactatemia and blood cultures positive for Sti-eprococcus pneumoniae, in a 70-year old pat ient. On two occasions (5 days, and 2 days before the patient's death) , the relationship between oxygen delivery (DO2) and consumption (VO2) was examined in conjunction with two presumed markers of tissue oxyge nation: the lactate/pyruvate ratio (L/P), and the beta-hydroxybutyrate acetoacetate ratio (beta OHB/AcAc). Increasing DO2 by about 30% (''ox ygen flux test'') failed to increase VO2. The beta OHB/AcAc ratio rema ined within normal limits, thus suggesting uncompromised tissue oxygen ation at the hepatic level. The L/P ratio remained persistently above normal limits, thus suggesting actual organ or regional hypoxia. This case shows that during an overwhelming septic shock, the ''oxygen flux test'' can be negative, despite the presence of hyperlactatemia and o f an increased L/P ratio suggestive of impaired tissue oxygenation.