Lactate is produced when the body metabolizes glucose for energy. Lactate is a normal by-product of muscle metabolism and is present in blood at low levels.
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Multiple clinical studies have shown that a single measure of serum lactate is predictive of mortality in critically ill patients.1-3 Lactate is produced by anaerobic metabolism and is typically cleared by the liver. However, in critically ill patients, lactate clearance may be impaired due to diminished liver function or other factors. As a result, serum lactate levels may increase, which can lead to tissue hypoxia and death.
Measuring serum lactate levels can therefore provide important information about a patient’s prognosis and can guide treatment decisions. In addition, obtaining a serum lactate level is relatively simple and quick, making it a valuable tool in the initial assessment of critically ill patients.
What is serum lactate?
Serum lactate is a measure of the level of lactic acid in the blood. Lactic acid is produced when the body breaks down glucose for energy. The level of lactic acid in the blood can increase during exercise, when there is not enough oxygen available for the body to break down glucose, or during periods of stress or illness.
Serum lactate levels can be a useful tool for assessing someone’s health. For example, high levels of serum lactate may be seen in people with sepsis (a serious infection) or cancer. Measuring serum lactate can also help to guide treatment decisions, such as whether or not to give someone oxygen therapy.
How is serum lactate measured?
Serum lactate is measured by taking a small sample of blood from a vein, usually in the arm. The blood sample is then sent to a laboratory for analysis.
Why is a measure of serum lactate obtained in the initial assessment?
A measure of serum lactate is obtained in the initial assessment for several reasons. First, serum lactate is a marker of tissue hypoxia. Tissue hypoxia results when the oxygen demand of the tissues exceeds the oxygen supply. This can happen when the blood flow to the tissues is diminished (as can happen with coagulopathies or hypovolemia), when the oxygen-carrying capacity of the blood is decreased (as can happen with anemia), or when the amount of oxygen available in the tissue is decreased (as can happen with carbon monoxide poisoning). In all of these cases, the level of serum lactate will be elevated.
Second, serum lactate is a marker of anaerobic metabolism. When cells are unable to obtain enough oxygen to meet their energy demands, they resort to anaerobic metabolism. This results in the production of lactic acid, which accumulates in the blood and causes the serum lactate level to rise.
Third, a high serum lactate level may indicate that a patient is at risk for developing lactic acidosis. Lactic acidosis is a condition that occurs when there is too much lactic acid in the blood. It can be life-threatening if not treated promptly.
Finally, a high serum lactate level may also indicate that a patient is at risk for developing sepsis or septic shock. Sepsis is a life-threatening condition that occurs when an infection spreads throughout the body. Septic shock is a potentially fatal complication of sepsis that occurs when there is decreased blood flow to vital organs as a result of the infection.
How does serum lactate affect the body?
When your cells produce energy, they create a by-product called lactate. Lactate is continually produced during exercise and is removed from the blood by the liver. In healthy individuals, lactate production increases during exercise as your muscles work harder and demand more energy. The amount of lactate in your blood typically stays within a normal range.
However, if your body can’t remove lactate from the blood as quickly as it’s produced, levels will rise. This can happen when you exercise too hard, are ill or have certain medical conditions. A high level of lactate in the blood is called lactic acidosis. Lactic acidosis is a medical emergency that requires immediate treatment.
There is no clear consensus on why a measure of serum lactate is obtained in the initial assessment of critically ill patients. While some studies have shown that lactate levels are associated with mortality, others have not been able to replicate these findings. A systematic review of the literature did not find strong evidence to support the routine use of lactate measurements in critically ill patients. More research is needed to determine the utility of serum lactate measurements in this population.