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Stress hyperlactataemia: present understanding and controversy.

Mercedes Garcia-Alvarez1, Paul Marik2, Rinaldo Bellomo3

  • 1Department of Anaesthesiology, Hospital de Sant Pau, Barcelona, Spain; Department of Intensive Care Medicine, Austin Hospital, Melbourne, Australia.

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Stress hyperlactataemia, common in exercise and disease, is increasingly understood as aerobic lactate production, not just anaerobic glycolysis. This protective mechanism, linked to adrenergic stimulation, impacts energy metabolism and offers new clinical insights.

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Area of Science:

  • Physiology
  • Biochemistry
  • Pathophysiology

Background:

  • Increased blood lactate concentration (stress hyperlactataemia) is prevalent in physiological and pathophysiological states.
  • Stress hyperlactataemia is a significant independent predictor of mortality in disease.
  • The origins and mechanisms of exercise- and disease-associated stress hyperlactataemia remain debated.

Purpose of the Study:

  • To review current understanding and controversies surrounding the source, biochemistry, and physiology of stress hyperlactataemia.
  • To highlight recent evidence challenging the traditional paradigm of anaerobic glycolysis as the sole cause.
  • To discuss the implications of new insights into lactate production and its role.

Main Methods:

  • Review of existing literature and evidence on lactate metabolism.
  • Analysis of studies investigating aerobic lactate production and adrenergic stimulation.
  • Discussion of lactate's role as a protective mechanism and signaling molecule.

Main Results:

  • Evidence suggests stress hyperlactataemia arises from increased aerobic lactate production, potentially with reduced clearance.
  • Adrenergic stimulation is associated with and likely drives this increased lactate production.
  • Lactate functions as an evolutionarily preserved mechanism for bioenergetic efficiency and gluconeogenesis.

Conclusions:

  • Lactate acts as a hormone, modulating protein expression to enhance energy utilization and metabolism.
  • Clinicians must understand these advances for improved patient management strategies.
  • New perspectives on stress hyperlactataemia necessitate a re-evaluation of patient care principles.