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[Lactic acidosis - update 2018].

Stefan Kluge1, Geraldine de Heer1, Dominik Jarczak1

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This summary is machine-generated.

Severe hyperlactaemia indicates critical illness, often from sepsis or shock. Prompt lactate monitoring and intervention significantly improve survival outcomes in intensive care patients.

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Area of Science:

  • Critical Care Medicine
  • Biochemistry
  • Clinical Diagnostics

Background:

  • Severe hyperlactaemia is a critical indicator in intensive care, frequently linked to sepsis, septic shock, cardiogenic shock, or hemorrhagic shock.
  • Elevated serum lactate levels are an independent predictor of mortality across diverse critically ill patient populations.
  • Lactate levels exceeding 10 mmol/l are associated with an 80% mortality rate in intensive care, with persistence for 48 hours leading to universal death.

Purpose of the Study:

  • To highlight the diagnostic and prognostic significance of hyperlactaemia in intensive care.
  • To emphasize the importance of timely lactate level assessment and monitoring in critically ill patients.
  • To discuss the role of lactate levels and clearance in guiding sepsis management and predicting outcomes.

Main Methods:

  • Review of current literature and clinical guidelines regarding hyperlactaemia management in intensive care.
  • Analysis of the association between serum lactate concentrations, lactate clearance, and patient mortality.
  • Integration of the new sepsis definition and Surviving Sepsis Campaign guidelines concerning lactate monitoring.

Main Results:

  • Serum lactate > 2 mmol/l is a criterion for septic shock in the updated sepsis definition.
  • The Surviving Sepsis Campaign's 1-hour bundle includes lactate determination as a primary measure.
  • Lactate clearance is a strong prognostic indicator for survival, particularly in patients with baseline lactate > 5 mmol/l.
  • Liver function impairment prolongs lactate metabolism, impacting its prognostic value in cirrhosis patients.

Conclusions:

  • Prompt diagnostic work-up and classification are essential for increased lactate levels.
  • Lactate monitoring and clearance are crucial for guiding resuscitation and predicting outcomes in critically ill patients.
  • Improved lactate clearance correlates with better patient outcomes, underscoring its therapeutic significance.