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Hyperlactatemia: An Update on Postoperative Lactate.

Elizabeth H Stephens1, Conrad L Epting2,3, Carl L Backer1

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|April 16, 2020
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Summary
This summary is machine-generated.

Postoperative hyperlactatemia in pediatric cardiac surgery patients is not always due to hypoperfusion. Type B hyperlactatemia, often linked to increased glycolysis from stress, may indicate a benign condition manageable with expectant care.

Keywords:
CPB physiology/pathophysiologybiochemistryinflammationischemia/reperfusion

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Area of Science:

  • Biochemistry
  • Pediatric Cardiology
  • Critical Care Medicine

Background:

  • Hyperlactatemia in pediatric cardiac surgery was historically attributed solely to hypoperfusion.
  • Evolving understanding highlights complex lactate generation, clearance, and management.
  • Contemporary lactate balance assessment is crucial for postoperative care.

Purpose of the Study:

  • To review current knowledge of lactate metabolism in pediatric cardiac surgery patients.
  • To differentiate between Type A (hypoxia-driven) and Type B (glycolysis-driven) hyperlactatemia.
  • To guide management strategies for hyperlactatemia in this population.

Main Methods:

  • Literature review of lactate metabolism and hyperlactatemia in pediatric cardiac surgery.
  • Analysis of the distinct pathophysiological mechanisms of Type A and Type B hyperlactatemia.
  • Discussion of clinical presentation and diagnostic indicators for each type.

Main Results:

  • Type A hyperlactatemia results from inadequate oxygen delivery and tissue hypoxia.
  • Type B hyperlactatemia in this cohort is primarily due to increased glycolysis from the stress response.
  • Type B hyperlactatemia can coexist with Type A and is often associated with balanced metabolic acidosis and hyperglycemia in well-perfused patients.

Conclusions:

  • Differentiating between Type A and Type B hyperlactatemia is essential for appropriate patient management.
  • Patients with adequate perfusion and Type B hyperlactatemia may have a benign clinical course.
  • Expectant management is a viable strategy for select pediatric cardiac surgery patients with Type B hyperlactatemia.