Clinical use of lactate monitoring in critically ill patients

Abstract

Increased blood lactate levels (hyperlactataemia) are common in critically ill patients. Although frequently used to diagnose inadequate tissue oxygenation, other processes not related to tissue oxygenation may increase lactate levels. Especially in critically ill patients, increased glycolysis may be an important cause of hyperlactataemia. Nevertheless, the presence of increased lactate levels has important implications for the morbidity and mortality of the hyperlactataemic patients. Although the term lactic acidosis is frequently used, a significant relationship between lactate and pH only exists at higher lactate levels. The term lactate associated acidosis is therefore more appropriate. Two recent studies have underscored the importance of monitoring lactate levels and adjust treatment to the change in lactate levels in early resuscitation. As lactate levels can be measured rapidly at the bedside from various sources, structured lactate measurements should be incorporated in resuscitation protocols.

Acid Base Disorders in Critically Ill Neonatal Intensive Care Patients and Predicting Survival by the Presence of Deranged Acid-Base Variables

“…In critical illness, there is usually concurrent hypoalbuminaemia which covers the metabolic acidosis [16]. Also the unmeasured ions leads to change in anion gap, anions increase , whereas cations decrease the anion gap.…”

Serum lactate as predictor and diagnostic biomarker of plasma leakage in adult dengue patients

“…When perfusion is maintained the lactate level may decrease. (28) According to the 1997 WHO guideline, plasma leakage is determined by the presence of hemoconcentration as reflected by increased hematocrit level of ≥20% and/or thrombocytopenia of <100,000/mm 3 . A limitation to these criteria is that baseline hematocrit values are commonly not available, and may be misleading in the presence of anemia or hemorrhage and during the early phase of resuscitation.…”

Metabolic response to subacute and subchronic iron overload in a rat model

“…Because the rate of glycolysis can increase faster by several orders of magnitude than oxidative phosphorylation, glycolysis can briefly provide far more ATP when most required under stress conditions. Excess pyruvate will rapidly accumulate and is diverted to lactate in order for glycolysis to proceed [4]. It could be concluded that the observed hyperlactatemia is due to decreased anaerobic threshold and premature entering the anaerobic system with accelerated glycolysis that overwhelms lactate utilization and clearance.…”

“…Although hyperlactatemia is frequently used to diagnose inadequate tissue oxygenation, other processes not related to tissue oxygenation may increase lactate levels. The current hyperlactatemia mostly refers to lactate potential to serve as a critical buffer allowing glycolysis to accelerate when large additional amounts of energy are rapidly required under circumstances of ironinduced cellular stress [4]. Iron-induced hyperlactatemia could thus be due to impaired lactate clearance rather than hypoxic tissue production of lactate [7].…”

“…CORT in the blood is mostly unbound and can usually be demonstrated after few minutes, which makes plasma CORT a useful parameter for measurement of acute stress [27]. Lactate is another main effector in rodent stress system that helps organisms survive stressful situations [4].…”