Etiology and therapeutic approach to elevated lactate levels.
Lactate levels are commonly evaluated in acutely ill patients. Although most often used in the context of evaluating shock, lactate levels can be elevated for many reasons. While tissue hypoperfusion may be the most common cause of elevation, many other etiologies or contributing factors exist. Clinicians need to be aware of the many potential causes of lactate level elevation as the clinical and prognostic importance of an elevated lactate level varies widely by disease state. Moreover, specific therapy may need to be tailored to the underlying cause of elevation. The present review is based on a comprehensive PubMed search between the dates of January 1, 1960, to April 30, 2013, using the search term lactate or lactic acidosis combined with known associations, such as shock, sepsis, cardiac arrest, trauma, seizure, ischemia, diabetic ketoacidosis, thiamine, malignancy, liver, toxins, overdose, and medication. We provide an overview of the pathogenesis of lactate level elevation followed by an in-depth look at the varied etiologies, including medication-related causes. The strengths and weaknesses of lactate as a diagnostic/prognostic tool and its potential use as a clinical end point of resuscitation are discussed. The review ends with some general recommendations on the management of patients with elevated lactate levels.
Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Lars W
LW
Andersen
Julie
J
Mackenhauer
Jonathan C
JC
Roberts
Katherine M
KM
Berg
Michael N
MN
Cocchi
Michael W
MW
Donnino
D015415:Biomarkers / Q000032:analysis; D064420:Drug-Related Side Effects and Adverse Reactions; D006323:Heart Arrest / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D039781:PubMed; D012720:Severity of Illness Index; D012769:Shock / Q000150:complications / Q000175:diagnosis / Q000378:metabolism
D015415:Biomarkers; D019344:Lactic Acid
DKA; ScvO(2); central venous oxygen saturation; diabetic ketoacidosis