Continuous monitoring of blood lactate and ongoing targeting of blood lactate via nutritional support

Abstract

Systems, techniques and methods for estimating the metabolic state or flux, e.g., the body energy state (“BES”) of a patient, are disclosed. The BES provides a deep insight into the nutritional needs of the patient, thus allowing for a sort of exquisite glycemic control with regard to the patient. The invention discloses systems and methods for estimating fractional gluconeogenesis. The invention also discloses systems and methods for estimating and targeting patient blood lactate concentration, both as a target itself and as an intermediate step to estimating and targeting patient fractional gluconeogenesis glucose production. Nutritional support methods and formulations are also disclosed. The invention is suitable for any sort of patient, including those who are injured, such as with traumatic brain injury, ill, or have other conditions that stress the metabolic system.

What is claimed is: 
     
         1 . A method of treating body wasting in a human patient, the method comprising:
 receiving a blood lactate concentration of the patient, from a lactate analyzer that has analyzed a blood sample of the patient, the blood lactate concentration received directly from the lactate analyzer or indirectly from the lactate analyzer over a network; and   based on the received blood lactate concentration of the patient, if the blood lactate concentration is less than about 2.0 mM, administering a nutritional support to the patient.   
     
     
         2 . The method of  claim 1  wherein the nutritional support comprises a gluconeogenic precursor or a monocarboxylic compound or both. 
     
     
         3 . The method of  claim 1  wherein the nutritional support comprises one or more salts. 
     
     
         4 . The method of  claim 1  wherein the primary or sole illness of the patient is the body wasting. 
     
     
         5 . The method of  claim 1  wherein the primary cause of the body wasting is nutritional deficit. 
     
     
         6 . The method of  claim 1  wherein the nutritional support is enteral, parenteral, or both. 
     
     
         7 . The method of  claim 1  wherein the nutritional support comprises one or more of the following: glycerol, glycerol tri-lactate, glycerol tri-acetate, arginyl lactate, lactate N-acetylcysteine ester, pyruvate, acetoacetate, or beta-hydroxy butyrate. 
     
     
         8 . The method of  claim 1  wherein the method further targets a fractional gluconeogenesis range of values. 
     
     
         9 . The method of  claim 1  wherein the method further targets a blood glucose range of values. 
     
     
         10 . The method of  claim 1  wherein the method further targets a blood lactate to pyruvate ratio of at least about 10. 
     
     
         11 . A method of treating body wasting in a human patient, the method comprising:
 taking a blood sample from the patient;   analyzing the blood sample with a lactate analyzer;   transmitting a blood lactate concentration of the patient over a network or directly to a computing or storage device; and   based on the transmitted blood lactate concentration if the blood lactate concentration is less than about 2.0 mM, administering a nutritional support.   
     
     
         12 . The method of  claim 11  wherein the nutritional support comprises a gluconeogenic precursor or a monocarboxylic compound or both. 
     
     
         13 . The method of  claim 11  wherein the nutritional support comprises one or more salts. 
     
     
         14 . The method of  claim 11  wherein the primary or sole illness of the patient is the body wasting. 
     
     
         15 . The method of  claim 11  wherein the primary cause of the body wasting is nutritional deficit. 
     
     
         16 . The method of  claim 11  wherein the nutritional support is enteral, parenteral, or both. 
     
     
         17 . The method of  claim 11  wherein the nutritional support comprises one or more of the following: glycerol, glycerol tri-lactate, glycerol tri-acetate, arginyl lactate, lactate N-acetylcysteine ester, pyruvate, acetoacetate, or beta-hydroxy butyrate. 
     
     
         18 . The method of  claim 11  wherein the method further targets a fractional gluconeogenesis range of values. 
     
     
         19 . The method of  claim 11  wherein the method further targets a blood glucose range of values. 
     
     
         20 . The method of  claim 11  wherein the method further targets a blood lactate to pyruvate ratio of at least about 10. 
     
     
         21 . A method of preventing or treating body wasting in a human patient, the method comprising:
 receiving a blood lactate concentration of the patient, from a lactate analyzer that has analyzed a blood sample of the patient, the blood lactate concentration received directly from the lactate analyzer or indirectly from the lactate analyzer over a network;   administering, based on the received blood lactate concentration of the patient, if the blood lactate concentration is less than about 2.0 mM, a nutritional support to the patient; and   
     
     
         22 . The method of  claim 21  wherein the nutritional support comprises a gluconeogenic precursor or a monocarboxylic compound or both. 
     
     
         23 . The method of  claim 21  wherein the nutritional support comprises one or more salts. 
     
     
         24 . The method of  claim 21  wherein the primary or sole illness of the patient is the body wasting. 
     
     
         25 . The method of  claim 21  wherein the primary cause of the body wasting is nutritional deficit. 
     
     
         26 . The method of  claim 21  wherein the nutritional support is enteral, parenteral, or both. 
     
     
         27 . The method of  claim 21  wherein the nutritional support comprises one or more of the following: glycerol, glycerol tri-lactate, glycerol tri-acetate, arginyl lactate, lactate N-acetylcysteine ester, pyruvate, acetoacetate, or beta-hydroxy butyrate. 
     
     
         28 . The method of  claim 21  wherein the method further targets a fractional gluconeogenesis range of values. 
     
     
         29 . The method of  claim 21  wherein the method further targets a blood glucose range of values. 
     
     
         30 . The method of  claim 21  wherein the method further targets a blood lactate to pyruvate ratio of at least about 10. 
     
     
         31 . A method of preventing or treating body wasting in a human patient, the method comprising:
 taking a blood sample from the patient;   analyzing the blood sample with a lactate analyzer;   transmitting a blood lactate concentration of the patient over a network or directly to a computing or storage device; and   administering, based on the transmitted blood lactate concentration if the blood lactate concentration is less than about 2.0 mM, a nutritional support; and   repeating the taking, analyzing, transmitting and administering at least once.   
     
     
         32 . The method of  claim 31  wherein the nutritional support comprises a gluconeogenic precursor or a monocarboxylic compound or both. 
     
     
         33 . The method of  claim 31  wherein the nutritional support comprises one or more salts. 
     
     
         34 . The method of  claim 31  wherein the primary or sole illness of the patient is the body wasting. 
     
     
         35 . The method of  claim 31  wherein the primary cause of the body wasting is nutritional deficit. 
     
     
         36 . The method of  claim 31  wherein the nutritional support is enteral, parenteral, or both. 
     
     
         37 . The method of  claim 31  wherein the nutritional support comprises one or more of the following: glycerol, glycerol tri-lactate, glycerol tri-acetate, arginyl lactate, lactate N-acetylcysteine ester, pyruvate, acetoacetate, or beta-hydroxy butyrate. 
     
     
         38 . The method of  claim 31  wherein the method further targets a fractional gluconeogenesis range of values. 
     
     
         39 . The method of  claim 31  wherein the method further targets a blood glucose range of values. 
     
     
         40 . The method of  claim 31  wherein the method further targets a blood lactate to pyruvate ratio of at least about  10 .