Approach to Elevated Lactate Levels

Review: Etiology and Therapeutic Approach to Elevated Lactate Levels.

An elevated lactate is associated with increased mortality. If the lactate is cleared it is associated with better outcome. Lactate is the best means to screen for occult severe sepsis. In the River’s Trial, almost 1/5 of the patients with severe sepsis had a completely normal blood pressure (MAP > 100), Almost ½ of the patients didn’t have a SBP < 90 when their lactate was discovered to be high.
This article from Mayo clinic is a detail review of etiology and therapeutic approach to elevated lactate levels.

Article highlights following points.

1. Lactate levels can be caused by variety of conditions including shock, sepsis, cardiac arrest, trauma, seizure, ischemia, diabetic ketoacidosis, thiamine deficiency, Malignancy, liver dysfunction, genetic disorders, toxins and medications.
2. Elvated lactate levels have been associated with increased mortality rates in 3 variety of diseases, such as sepsis, trauma and cardiac arrest.
3. Decreased lactate clearance has been found to be associated with increased mortallty rates in sepsis, pose-cardiac arrest, trauma, burns, and other conditions.
4. The use of lactate clearance as an end point of resuscitation might prove beneficial, but further research is warranted.
   When approaching the patient with an elevated lactate Ievels, the possibility of a multifactorial etiology must be considered.
5. Despite its Imperfect  sensitivity and specificity lactate assay remains clinically useful test that can alert a clinician to un- derlying hypoperfusion  in need  of Immediate treatment or an etiology not readily apparent on initial evaluation.

Good Read! Link for full article Here