The riddle of hyperlactatemia.
A recent observational study in a large cohort of critically ill patients confirms the association between hyperlactatemia and mortality. The mechanisms regulating the rates of lactate production and clearance in critical illness remain poorly understood. During exercise, hyperlactatemia clearly results from an imbalance between oxygen delivery and energy requirements. In critically ill patients, the genesis of hyperlactatemia is significantly more complex. Possible mechanisms include regional hypoperfusion, an inflammation-induced upregulation of the glycolitic flux, alterations in lactate-clearing mechanisms, and increases in the work of breathing. Understanding how these complex processes interact to produce elevations in lactate continues to be an important area of research.
Gutierrez
Guillermo
G
The George Washington University, Medical Faculty Associates, 2150 Pennsylvania Avenue, N,W, Suite 5-427, Washington, DC 20037, USA. ggutierrez@mfa.gwu.edu
Williams
Jeffrey D
JD
D016638:Critical Illness / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D019344:Lactic Acid / Q000009:adverse effects / Q000097:blood* / Q000378:metabolism
D019344:Lactic Acid
Chest. 1996 Jul;110(1):198-204
8681628
Intensive Care Med. 2007 Nov;33(11):1967-71
17661014
Intensive Care Med. 1998 Apr;24(4):304-12
9609407
Circulation. 1970 Jun;41(6):989-1001
5482913
Respir Physiol. 1999 Dec 1;118(2-3):103-15
10647856
Can Med Assoc J. 1964 Mar 14;90:673-5
14127378
Crit Care. 2009;13(3):R90
19523194
Am J Physiol Regul Integr Comp Physiol. 2004 Apr;286(4):R686-92
14695114
Chest. 1985 May;87(5):580-4
3987371
Intensive Care Med. 1996 Jan;22(1):6-16
8857432
N Engl J Med. 1995 Oct 19;333(16):1025-32
7675044
J Crit Care. 1996 Mar;11(1):2-8
8904278
Intensive Care Med. 1996 Jan;22(1):17-25
8857433