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Development Team Member
Posts: 1,501
Lactate analyzer measure lactate , NIRS devices measure  SmO2   and tHb trends.
  I like to  show you an email I got   to look for a possible answer in the use of lactate in specific  cases.

Than I lie to throw the  question out on how  MOXY  would react in this case. Including the question, why lactate  actually may indicate the   problem  .

The  question I  got.
  Can cyanide poisoning  show up   when using lactate as a  possible marker to   the problem

Some very  short info to this case.
As we now by know  lactate production due to hypoxia  is rather the exception than the rule ( Roberge) lactate is  always  produce  and   there. Only  when the production or  the utilization of O2 is out of  balance  do we see an  increase or decrease if   a certain amounts  circulating in the  system.

This  was  a  fundamental   part of  our  own  LBP idea when we looked  for lactate trends  and  possible metabolic balance.

So  here  what is interesting

When we are active  and demand O2  as the primary energy source, the hemoglobin tetramer undergoes subtle intramolecular conformational changes called cooperativity.
The result of this cooperativity, after the first oxygen has been unloaded, than the unloading of the second oxygen is much easier (facilitated). This means that the second oxygen can dissociate after a much smaller change in oxygen pressure than was needed to unload the  initial first one. Another conformational change facilitates dissociation of the third oxygen.
  So  you can see that the Cooperativity is an important phenomenon that permits the loading and unloading of large amounts of oxygen at physiologically relevant oxygen pressures.

 Now certain  Chemicals  can  interfere with oxygen transport and/or cooperativity  and than will be therefor  very harmful to lethal. Before the complete  disaster     lactate  and possible  NIRS  could give  some warning feedback  and possibly  time  to  avoid the   deadly reaction.  Here why lactate  could  be  a  warning feedback lie it is  in sepsis.

In general  we  learn.

Oxygen lack is known as hypoxia; the complete absence of oxygen is called anoxia.

Andri  just sent a nice internal  group memo  out on the discussion and definition of the different  O2  reactions. He may  share this on here  more  to a bigger  audience.

for the moment  very short here the  four basic types  we  could see in hypoxia  in our case.

1. Stagnant or hypokinetic hypoxia

2. Arterial or anoxic hypoxia

3. hypoxia as it is know as anemic hypoxia

And now last but not least our case  email  question

histotoxic hypoxia

Now  as you will see  due to the specificity of the  reaction  some  immediate will argue that this is not a real  HYPOXIA.
Because both the arterial oxygen tension and the oxygen content of blood are normal.
The lesion here is caused by poisons such as cyanide or hydrogen sulfide, which block the utilization of oxygen at the cellular level.

We name this bio availability of  O2. Remember we  can create this as well during a physiological training  with some specific  intervention so we  can go hypoxic in a very low  intensity like during walking or  100 watt cycling  or slow  stepper  or  very slow rowing  or  in individual muscle group  workouts.

Now look   the problem  when we use  the blood values  which would b consider incredible accurate. They  do not  show  a problem with O2.
 So as we  do not  are able to use  O2 we  will see a delayed  but reaction in lactate   values like we see in sepsis ( different reason or mechanism there)
 BUT now think carefully  how  MOXY  may  give us as well a hint in the  O2  problem. and why a combination sometimes is needed  to have  better  answer.

So  short answer. 
Yes lactate  can or could give a hint of Cyanide  poisoning or  trend of the substance in the body.

Any other comment is appreciated


Development Team Member
Posts: 2
In the case of cyanide of hydrogen sulfide with MOXY, would there be an increase in de-oxy Hb and no change in oxy Hb? This would look puzzling if you were expecting to see the typical relationship of ox and de-oxy Hb.

I wouldn't recommend anyone experiment with cyanide or H2s.

If the pt were exposed, and had some exertion there would be some relation to oxy & de-oxy.

How would one assess arterial or venous exposure, or would it be necessary.

Just curious about a biomarker (lactate similar with sepsis) or tool to measure in the field exposure to H2s or cyanide.

Juerg, it always takes a read or two to pick up on the swenglish, but it helps to reinforce thinking critically about topics.

Development Team Member
Posts: 1,501
Just very short a  small feedback here  as I was more interested  here to show   how lactate is used in ambulances  and otehr fields  by the means of  feedback   of some occurring possible problems.

John writes

In the case of cyanide of hydrogen sulfide with MOXY, would there be an increase in de-oxy Hb and no change in oxy Hb? This would look puzzling if you were expecting to see the typical relationship of ox and de-oxy Hb.

Now forget the cyanide section
 just take  this as a   today's  "puzzle solving "

increase in de-oxy Hb and no change in oxy Hb? This would look puzzling if you were expecting to see the typical relationship of ox and de-oxy Hb.

a) increase in HHb
b) no change in O2Hb

Possible questions we would ask.

1. What  happens  with  tHb

2. If  you  have this  answer.
 3. What causes   this change  and are there different  options  which can create this change
4. What  or how  would SmO2 look in this  cases.

5. Than you will end up  with a possible  answer on what activity or  what physiological  actions  woudl create a local  MOXY reactions like that. 

 This is the way  we  play with our high school students  the  MOXY puzzle  and   create some  theoretical   options,  with the goal to see, whether we  can actually  get the same picture  with  an activity and what  has to eb done to   actually see this options  happening if  they are possible in the   real world.  Once you  can play with this  you are a  huge step  closer  to  physiological   ideas of   how to stimulate  what ever you plan to stimulate.
  So  first step is  really just  learn or  hope to understand interpretations of NIRS trends  and than  move the theoretical options ion to  reality with  creating the  activity  for this  same pictures  if possible.
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