Systems and methods for monitoring of blood lactate and 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 system for providing nutritional support to a human patient wherein the patient is injured or ill, the system comprising:
 means for analyzing a blood lactate concentration of the patient; and   means for ceasing or decreasing a nutritional support to the patient, based on the blood lactate concentration of the patient, if the blood lactate concentration is greater than about 4.0 mM.   
     
     
         2 . The system of  claim 1  wherein the nutritional support comprises a gluconeogenic precursor or a monocarboxylic compound or both. 
     
     
         3 . The system of  claim 1  wherein the nutritional support comprises one or more salts. 
     
     
         4 . The system of  claim 1  wherein the nutritional support has a milliosmolality of less than about 1000. 
     
     
         5 . The system of  claim 1  wherein the nutritional support comprises an amino acid. 
     
     
         6 . The system 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. 
     
     
         7 . The system of  claim 1  wherein the nutritional support is administered at a rate of about 1-4.5 mg/kg/min where kg is kg of patient body weight and mg is the amount of gluconeogenic precursor or monocarboxylic compound in the nutritional support. 
     
     
         8 . The system of  claim 1  wherein the nutritional support is administered at a rate of about 10-50 micromoles/kg/min, where kg is kg of patient body weight and micromoles is the amount of gluconeogenic precursor or monocarboxylic compound in the nutritional support. 
     
     
         9 . The system of  claim 1  wherein at least one of the means comprises software running on a general purpose computer. 
     
     
         10 . The system of  claim 1  wherein at least one of the means comprises embedded hardware circuitry. 
     
     
         11 . A system for providing nutritional support to a human patient wherein the patient is injured or ill, the system comprising:
 means for processing a blood lactate concentration of the patient, that has been received from a means for analyzing blood lactate that has analyzed a blood sample of the patient, the blood lactate concentration received directly from the means for analyzing lactate or indirectly over a network; and   means for ceasing or decreasing, based on the received blood lactate concentration of the patient, if the blood lactate concentration is greater than about 4.0 mM, a nutritional support to the patient.   
     
     
         12 . The system of  claim 11  wherein the nutritional support comprises a gluconeogenic precursor or a monocarboxylic compound or both. 
     
     
         13 . The system of  claim 11  wherein the nutritional support comprises one or more salts. 
     
     
         14 . The system of  claim 11  wherein the nutritional support has a milliosmolality of less than about 1000. 
     
     
         15 . The system of  claim 11  wherein the nutritional support comprises an amino acid. 
     
     
         16 . The system 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. 
     
     
         17 . The system of  claim 11  wherein the nutritional support is administered at a rate of about 1-4.5 mg/kg/min where kg is kg of patient body weight and mg is the amount of gluconeogenic precursor or monocarboxylic compound in the nutritional support. 
     
     
         18 . The system of  claim 11  wherein the nutritional support is administered at a rate of about 10-50 micromoles/kg/min, where kg is kg of patient body weight and micromoles is the amount of gluconeogenic precursor or monocarboxylic compound in the nutritional support. 
     
     
         19 . The system of  claim 11  wherein at least one of the means comprises software running on a general purpose computer. 
     
     
         20 . The system of  claim 11  wherein at least one of the means comprises embedded hardware circuitry. 
     
     
         21 . A system for providing nutritional support to a human patient, the system comprising:
 means for analyzing a blood lactate concentration of the patient; and   means for ceasing or decreasing the rate of administration of a nutritional support to the patient, based on the blood lactate concentration of the patient, if the blood lactate concentration is greater than about 4.0 mM.   
     
     
         22 . The system of  claim 21  wherein the nutritional support comprises a gluconeogenic precursor or a monocarboxylic compound or both. 
     
     
         23 . The system of  claim 21  wherein the nutritional support comprises one or more salts. 
     
     
         24 . The system of  claim 21  wherein the nutritional support has a milliosmolality of less than about 1000. 
     
     
         25 . The system of  claim 21  wherein the nutritional support comprises an amino acid. 
     
     
         26 . The system 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. 
     
     
         27 . The system of  claim 21  wherein the nutritional support is administered at a rate of about 1-4.5 mg/kg/min where kg is kg of patient body weight and mg is the amount of gluconeogenic precursor or monocarboxylic compound in the nutritional support. 
     
     
         28 . The system of  claim 21  wherein the nutritional support is administered at a rate of about 10-50 micromoles/kg/min, where kg is kg of patient body weight and micromoles is the amount of gluconeogenic precursor or monocarboxylic compound in the nutritional support. 
     
     
         29 . The system of  claim 21  wherein at least one of the means comprises software running on a general purpose computer. 
     
     
         30 . The system of  claim 21  wherein at least one of the means comprises embedded hardware circuitry. 
     
     
         31 . A system for providing nutritional support to a human patient, the system comprising:
 means for processing a blood lactate concentration of the patient, that has been received from a means for analyzing blood lactate that has analyzed a blood sample of the patient, the blood lactate concentration received directly from the means for means for ceasing or decreasing the rate of administration of a nutritional support to the patient, based on the blood lactate concentration of the patient, if the blood lactate concentration is greater than about 4.0 mM.   
     
     
         32 . The system of  claim 31  wherein the nutritional support comprises a gluconeogenic precursor or a monocarboxylic compound or both. 
     
     
         33 . The system of  claim 31  wherein the nutritional support comprises one or more salts. 
     
     
         34 . The system of  claim 31  wherein the nutritional support has a milliosmolality of less than about 1000. 
     
     
         35 . The system of  claim 31  wherein the nutritional support comprises an amino acid. 
     
     
         36 . The system 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. 
     
     
         37 . The system of  claim 31  wherein the nutritional support is administered at a rate of about 1-4.5 mg/kg/min where kg is kg of patient body weight and mg is the amount of gluconeogenic precursor or monocarboxylic compound in the nutritional support. 
     
     
         38 . The system of  claim 31  wherein the nutritional support is administered at a rate of about 10-50 micromoles/kg/min, where kg is kg of patient body weight and micromoles is the amount of gluconeogenic precursor or monocarboxylic compound in the nutritional support. 
     
     
         39 . The system of  claim 31  wherein at least one of the means comprises software running on a general purpose computer. 
     
     
         40 . The system of  claim 31  wherein at least one of the means comprises embedded hardware circuitry:
 means for ceasing or decreasing the rate of administration of a nutritional support to the patient, based on the blood lactate concentration of the patient, if the blood lactate concentration is greater than about 4.0 mM. 
 
     
     
         41 . A non-transitory computer-readable medium for storing software instructions that, when executed by a processor, executes a method for providing nutritional support to a human patient that is injured or ill, the method comprising:
 analyzing a blood lactate concentration of the patient; and   ceasing or decreasing a nutritional support to the patient, based on the received blood lactate concentration of the patient, if the blood lactate concentration is greater than about 4.0 mM.   
     
     
         42 . The non-transitory computer-readable medium of  claim 41  wherein the nutritional support comprises a gluconeogenic precursor or a monocarboxylic compound or both. 
     
     
         43 . The non-transitory computer-readable medium of  claim 41  wherein the nutritional support comprises one or more salts. 
     
     
         44 . The non-transitory computer-readable medium of  claim 41  of  claim 1  wherein the nutritional support has a milliosmolality of less than about 1000. 
     
     
         45 . The non-transitory computer-readable medium of  claim 41  wherein the nutritional support comprises an amino acid. 
     
     
         46 . The non-transitory computer-readable medium of  claim 41  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. 
     
     
         47 . The non-transitory computer-readable medium of  claim 41  wherein the nutritional support is administered at a rate of about 1-4.5 mg/kg/min where kg is kg of patient body weight and mg is the amount of gluconeogenic precursor or monocarboxylic compound in the nutritional support. 
     
     
         48 . The non-transitory computer-readable medium of  claim 41  wherein the nutritional support is administered at a rate of about 10-50 micromoles/kg/min, where kg is kg of patient body weight and micromoles is the amount of gluconeogenic precursor or monocarboxylic compound in the nutritional support. 
     
     
         49 . The non-transitory computer-readable medium of  claim 41  wherein the medium is at least partly-readable by a general purpose computer. 
     
     
         50 . The non-transitory computer-readable medium of  claim 41  wherein the medium is at least partly-readable by embedded hardware circuitry. 
     
     
         51 . A non-transitory computer-readable medium for storing software instructions that, when executed by a processor, executes a method for providing nutritional support to a human patient that is injured or ill, the method comprising:
 processing a blood lactate concentration of the patient, that has been received from a means for analyzing blood lactate that has analyzed a blood sample of the patient, the blood lactate concentration received directly from the blood lactate analyzer or indirectly over a network; and   ceasing or decreasing a nutritional support to the patient, based on the received blood lactate concentration of the patient, if the blood lactate concentration is greater than about 4.0 mM.   
     
     
         52 . The non-transitory computer-readable medium of  claim 51  wherein the nutritional support comprises a gluconeogenic precursor or a monocarboxylic compound or both. 
     
     
         53 . The non-transitory computer-readable medium of  claim 51  wherein the nutritional support comprises one or more salts. 
     
     
         54 . The non-transitory computer-readable medium of  claim 51  of  claim 1  wherein the nutritional support has a milliosmolality of less than about 1000. 
     
     
         55 . The non-transitory computer-readable medium of  claim 51  wherein the nutritional support comprises an amino acid. 
     
     
         56 . The non-transitory computer-readable medium of  claim 51  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. 
     
     
         57 . The non-transitory computer-readable medium of  claim 51  wherein the nutritional support is administered at a rate of about 1-4.5 mg/kg/min where kg is kg of patient body weight and mg is the amount of gluconeogenic precursor or monocarboxylic compound in the nutritional support. 
     
     
         58 . The non-transitory computer-readable medium of  claim 51  wherein the nutritional support is administered at a rate of about 10-50 micromoles/kg/min, where kg is kg of patient body weight and micromoles is the amount of gluconeogenic precursor or monocarboxylic compound in the nutritional support. 
     
     
         59 . The non-transitory computer-readable medium of  claim 51  wherein the medium is at least partly-readable by a general purpose computer. 
     
     
         60 . The non-transitory computer-readable medium of  claim 51  wherein the medium is at least partly-readable by embedded hardware circuitry.