title: Is serum lactate necessary in patients with normal anion gap and serum bicarbonate?
abstract: BACKGROUND
  There has been an increase in patients having serum lactate drawn in emergency situations. The objective of this study was to determine whether or not it was necessary to obtain a lactate level in patients with a normal serum bicarbonate level and anion gap.
  
  
  METHODS
  This is a retrospective chart review evaluation of 304 patients who had serum lactate and electrolytes measured in an emergency setting in one academic medical center.
  
  
  RESULTS
  In 66 patients who had elevated serum lactate (>2.2mmol/L), 45 (68%) patients had normal serum bicarbonate (SB) (greater than 21 mmol/L). Normal anion gap (AG) (normal range <16 mEq/l) was found in 51 of the 66 patients (77%).
  
  
  CONCLUSIONS
  We found that among patients with elevated serum lactate, 77% had a normal anion gap and 68% had normal serum bicarbonate. We conclude serum lactate should be drawn based on clinical suspicion of anaerobic tissue metabolism independent of serum bicarbonate or anion gap values.
authors.affiliation: Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida.
authors.forename: Daniel
authors.initials: D
authors.lastname: Aronovich
authors.affiliation: Mount Sinai Medical Center, Department of Internal Medicine, Miami Beach, Florida.
authors.forename: Maykel
authors.initials: M
authors.lastname: Trotter
authors.affiliation: Mount Sinai Medical Center, Department of Internal Medicine, Miami Beach, Florida.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rivera
authors.affiliation: Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida.
authors.forename: Michael
authors.initials: M
authors.lastname: Dalley
authors.affiliation: Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida.
authors.forename: David
authors.initials: D
authors.lastname: Farcy
authors.affiliation: Mount Sinai Medical Center, Department of Pathology, Miami Beach, Florida.
authors.forename: Michel
authors.initials: M
authors.lastname: Betancourt
authors.affiliation: Mount Sinai Medical Center, Department of Pathology, Miami Beach, Florida.
authors.forename: Lydia
authors.initials: L
authors.lastname: Howard
authors.affiliation: Mount Sinai Medical Center, Department of Pathology, Miami Beach, Florida.
authors.forename: Sharon
authors.initials: S
authors.lastname: Licciardi
authors.affiliation: Nova Southeastern University, Health Professions Division, Fort Lauderdale, Florida.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cubeddu
authors.affiliation: Mount Sinai Medical Center, Department of Internal Medicine, Miami Beach, Florida.
authors.forename: Robert
authors.initials: R
authors.lastname: Goldszer
mesh_terms: D000136:Acid-Base Equilibrium; D000137:Acid-Base Imbalance / Q000097:blood* / Q000150:complications; D000140:Acidosis, Lactic / Q000097:blood*; D000368:Aged; D001639:Bicarbonates / Q000097:blood*; D015687:Cell Hypoxia; D055416:Evidence-Based Emergency Medicine; D005260:Female; D006801:Humans; D007773:Lactates / Q000097:blood*; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012769:Shock / Q000097:blood* / Q000175:diagnosis
chemical_list: D001639:Bicarbonates; D007773:Lactates