Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice

PLoS One. 2012;7(8):e42745. doi: 10.1371/journal.pone.0042745. Epub 2012 Aug 6.

Abstract

Cerebrospinal fluid (CSF) analysis is an important tool in the diagnostic work-up of many neurological disorders, but reference ranges for CSF glucose, CSF/plasma glucose ratio and CSF lactate based on studies with large numbers of CSF samples are not available. Our aim was to define age-specific reference values. In 1993 The Nijmegen Observational CSF Study was started. Results of all CSF samples that were analyzed between 1993 and 2008 at our laboratory were systematically collected and stored in our computerized database. After exclusion of CSF samples with an unknown or elevated erythrocyte count, an elevated leucocyte count, elevated concentrations of bilirubin, free hemoglobin, or total protein 9,036 CSF samples were further studied for CSF glucose (n = 8,871), CSF/plasma glucose ratio (n = 4,516) and CSF lactate values (n = 7,614). CSF glucose, CSF/plasma glucose ratio and CSF lactate were age-, but not sex dependent. Age-specific reference ranges were defined as 5-95(th) percentile ranges. CSF glucose 5(th) percentile values ranged from 1.8 to 2.9 mmol/L and 95(th) percentile values from 3.8 to 5.6 mmol/L. CSF/plasma glucose ratio 5(th) percentile values ranged from 0.41 to 0.53 and 95(th) percentile values from 0.82 to 1.19. CSF lactate 5(th) percentile values ranged from 0.88 to 1.41 mmol/L and 95(th) percentile values from 2.00 to 2.71 mmol/L. Reference ranges for all three parameters were widest in neonates and narrowest in toddlers, with lower and upper limits increasing with age. These reference values allow a reliable interpretation of CSF results in everyday clinical practice. Furthermore, hypoglycemia was associated with an increased CSF/plasma glucose ratio, whereas hyperglycemia did not affect the CSF/plasma glucose ratio.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Aging / cerebrospinal fluid*
  • Blood Glucose / metabolism
  • Child
  • Child, Preschool
  • Glucose / cerebrospinal fluid*
  • Humans
  • Infant
  • Infant, Newborn
  • Lactic Acid / cerebrospinal fluid*
  • Middle Aged
  • Practice Patterns, Physicians'*
  • Reference Values
  • Young Adult

Substances

  • Blood Glucose
  • Lactic Acid
  • Glucose

Grants and funding

W. G. Leen was supported by The Netherlands Organization for Scientific Research (Project number 92003529; NWO; www.nwo.nl). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.