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Table 1 The characteristics of different components in fluid therapy

From: Pyruvate is a prospective alkalizer to correct hypoxic lactic acidosis

Component in solution Involved metabolic pathway Effect on correcting LA
Advantage Deficiency
Lactate The end-product in the glycolysis pathway Alleviating LA in moderate HS [28] through plasma expansion Not working in severe HS and aggravating glycolysis inhibition and lactate accumulation [31,32,33]
Acetate Metabolized to acetyl-CoA which is later used in the TCA cycle Alkalizing plasma quickly, not inhibiting glycolysis and not elevating lactate concentration [40] Side effect of impaired cardiac contractile response [41], inhibiting PDH activity [42]
Malate The key intermediate in the TCA cycle Working in cases of moderate acidosis [44] and moderate HS [46] and elevating energy production [45] May not be suitable for the LA under severe hypoxic conditions
Pyruvate The key intermediate in the glycolysis pathway and the TCA cycle Correcting LA in moderate and lethal HS animals [47,48,49, 52, 53], isolated failing human myocardium [57] and ischemia-reperfusion injury model [51] Not approved in clinic