Open AccessIschemic priapism as a model of exhausted metabolism
Author(s) -
Vreugdenhil Sanne,
Freire Jorge Pedro J.,
van Driel Mels F.,
Nijsten Maarten W.
Publication year - 2019
Publication title -
physiological reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 39
ISSN - 2051-817X
DOI - 10.14814/phy2.13999
Subject(s) - hyperlactatemia , pco2 , metabolic acidosis , lactic acid , lactic acidosis , medicine , hypoxia (environmental) , venous blood , carbohydrate metabolism , chemistry , endocrinology , oxygen , biology , genetics , organic chemistry , bacteria
In vivo metabolic studies typically concern complex open systems. However, a closed system allows better assessment of the metabolic limits. Ischemic priapism ( IP ) constitutes a special model of the compartment syndrome that allows direct sampling from a relatively large blood compartment formed by the corpora cavernosa ( CC ). The purpose of our study was to measure metabolic changes and the accumulation of end products within the CC during IP . Blood gas and biochemical analyses of aspirates of the CC were analyzed over an 8‐year period. Mean ± SD pH , pCO 2 , pO 2 , O 2 ‐saturation, lactate, and glucose of the aspirated blood were determined with a point‐of‐care analyzer. Forty‐seven initial samples from 21 patients had a pH of 6.91 ± 0.16, pCO 2 of 15.3 ± 4.4 kP a, pO 2 of 2.4 ± 2.0 kP a, and an O 2 ‐saturation of 19 ± 24% indicating severe hypoxia with severe combined respiratory and metabolic acidosis. Glucose and lactate levels were 1.1 ± 1.5 and 14.6 ± 4.8 mmol/L, respectively. pH and pCO 2 were inversely correlated ( R 2 = 0.86; P < 0.001), glucose and O 2 ‐saturation were positively correlated ( R 2 = 0.83; P < 0.001), and glucose and lactate were inversely correlated ( R 2 = 0.72; P < 0.001). The positive correlation of CO 2 and lactate ( R 2 = 0.69; P < 0.001) was similar to that observed in vitro , when blood was titrated with lactic acid. The observed combined acidosis underscores that IP behaves as a closed system where severe hypoxia and glycopenia coexist, indicating that virtually all energy reserves have been consumed.