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Etiology and therapeutic approach to elevated lactate levels
Lars W Andersen1, Julie Mackenhauer, Jonathan C Roberts
1Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Mayo Clinic Proceedings
|October 2, 2013
Summary
Elevated lactate levels in acutely ill patients have diverse causes beyond shock. Understanding these varied etiologies is crucial for accurate diagnosis and tailored treatment, improving patient outcomes.
Area of Science:
- Clinical Medicine
- Biochemistry
- Critical Care
Background:
- Lactate levels are frequently monitored in critically ill patients.
- Elevated lactate is often associated with shock but has numerous other causes.
- The clinical significance and prognostic value of elevated lactate vary by underlying condition.
Purpose of the Study:
- To review the diverse etiologies of elevated lactate levels in acutely ill patients.
- To discuss the role of lactate as a diagnostic and prognostic tool.
- To provide management recommendations for elevated lactate.
Main Methods:
- Comprehensive PubMed search from January 1, 1960, to April 30, 2013.
- Keywords included 'lactate' or 'lactic acidosis' combined with associated conditions (e.g., shock, sepsis, trauma, medications).
Main Results:
- Lactate elevation can result from numerous factors, including tissue hypoperfusion, sepsis, medications, and various diseases.
- The interpretation of lactate levels requires consideration of the specific clinical context.
- Medication-induced lactate elevation is a significant, often overlooked, cause.
Conclusions:
- Clinicians must recognize the wide range of lactate-elevating conditions.
- Tailoring therapy to the specific cause of lactate elevation is essential.
- Lactate's utility as a diagnostic marker and resuscitation endpoint requires careful evaluation within disease-specific contexts.
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