Ethanol and lactate: Is there a direct association?
Megan Audette1, Damilola Idowu1, Amy Zosel1
1Department of Emergency Medicine, Division of Medical Toxicology, Medical College of Wisconsin, Milwaukee, WI, USA.
The American Journal of Emergency Medicine
|September 19, 2025
Summary
Elevated serum lactate in patients with ethanol intoxication is not directly caused by alcohol. This study found no significant correlation, indicating other factors should be investigated when lactate levels are high.
Area of Science:
- Emergency Medicine
- Clinical Chemistry
- Toxicology
Background:
- Ethanol intoxication is common in Emergency Departments (EDs).
- Serum lactate is a biomarker for illness severity, potentially elevated in acute ethanol intoxication due to altered redox states.
- Lactate testing may be deferred in intoxicated patients due to interpretation uncertainty, a relationship that is unquantified.
Purpose of the Study:
- To investigate the correlation between serum ethanol and lactate concentrations in adult patients.
- To determine if ethanol intoxication alone is a significant cause of elevated lactate levels.
- To inform clinical practice regarding lactate testing in patients with ethanol intoxication.
Main Methods:
- Retrospective study of two adult patient cohorts (academic health system and Veterans Health Administration).
- Serum ethanol levels were measured during ED encounters.
- Patients with conditions or medications associated with lactic acidosis were excluded; regression analyses were performed.
Main Results:
- A poor correlation was found between ethanol and lactate concentrations in both the academic center (r² = 0.00110) and VHA (r = -0.00019, P = 0.9899) cohorts.
- Subgroup analyses of high ethanol concentrations (>80 mg/dL and >200 mg/dL) also showed poor correlation.
- No significant relationship was identified between ethanol levels and lactate concentrations.
Conclusions:
- Elevated lactate levels in patients with ethanol intoxication should not be solely attributed to alcohol consumption.
- Clinical decisions to defer lactate testing based on suspected ethanol intoxication are not supported by this data.
- Further investigation into alternative causes of elevated lactate is warranted in intoxicated patients.
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