Clinical use of lactate monitoring in critically ill patients
Open accessAbstract
Increased blood lactate levels (hyperlactataemia) are common in critically ill patients. Although frequently used to diagnose inadequate tissue oxygenation, other processes not related to tissue oxygenation may increase lactate levels. Especially in critically ill patients, increased glycolysis may be an important cause of hyperlactataemia. Nevertheless, the presence of increased lactate levels has important implications for the morbidity and mortality of the hyperlactataemic patients. Although the term lactic acidosis is frequently used, a significant relationship between lactate and pH only exists at higher lactate levels. The term lactate associated acidosis is therefore more appropriate. Two recent studies have underscored the importance of monitoring lactate levels and adjust treatment to the change in lactate levels in early resuscitation. As lactate levels can be measured rapidly at the bedside from various sources, structured lactate measurements should be incorporated in resuscitation protocols.
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Lactate can be effectively metabolized in the liver, explaining why it does not serve as an early marker of acute mesenteric ischaemia.
“Lactate can be effectively metabolized in the liver, explaining why it does not serve as an early marker of AMI.”
From Diagnostic accuracy of biomarkers to detect acute mesenteric ischaemia in adult patients: a systematic review and meta-analysis (2023) · cites this paper as [101]
The Review sections on lactate metabolism and clearance describe hepatic conversion of lactate and report that liver dysfunction impairs lactate clearance. The paper does not establish that hepatic metabolism makes lactate an unreliable early marker of acute mesenteric ischaemia; searches for mesenteric or intestinal ischaemia and early diagnostic use found no such passage. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIncreased metabolism may cover increased production, whereas decreased metabolism may lead to elevated lactate values without a relevant increase in production.
“Increased metabolism may cover increased production, whereas decreased metabolism may lead to elevated values without a relevant increase in production [101, 102].”
From Diagnostic accuracy of biomarkers to detect acute mesenteric ischaemia in adult patients: a systematic review and meta-analysis (2023) · cites this paper as [101]
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“Increased metabolism may cover increased production, whereas decreased metabolism may lead to elevated values without a relevant increase in production [101, 102].”
BackgroundLactate-guided resuscitation saves lives: We are not sure
Bakker, J., de Backer, D., & Hernandez, G. (2016) · Intensive Care Medicine · doi:10.1007/s00134-016-4220-z · Cited by 48 · see citing works
- Authors
- Bakker, J., Nijsten, M. W., & Jansen, T. C.
- Affiliations
- Erasmus MC (NL)
- University Medical Center Groningen (NL)
- Corresponding author
- Bakker, Jan
- Venue
- Annals of Intensive Care
- Publisher
- Elsevier BV
- Published
- 2013
- Volume
- 3
- Issue
- 1
- Pages
- 12
- ISSN
- 2110-5820 (ISSN-L)
- PMC
- PMC3654944
- OpenAlex
- W2129225365
- Cited by
- 473
- References
- 73
- Citations by year
- 2026: 44 · 2025: 37 · 2024: 36 · 2023: 28 · 2022: 42 · 2021: 50 · 2020: 41 · 2019: 41 · 2018: 26 · 2017: 44 · 2016: 41 · 2015: 21 · 2014: 20 · 2013: 2
- FWCI
- 20.40
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Annals of Intensive Care (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (acceptedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Nephrology › Renal function and acid-base balance
- Keywords
- lactate monitoring, hyperlactatemia, critically ill patients, tissue oxygenation, glycolysis, lactic acidosis, early resuscitation, resuscitation protocols, lactate measurement
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