Etiology and Therapeutic Approach to Elevated Lactate Levels
Lars W. Andersen,Julie Mackenhauer,Jonathan C. Roberts,Katherine Berg,Michael N. Cocchi,Michael W. Donnino +5 more
- Vol. 88, Iss: 10, pp 1127-1140
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TLDR
An overview of the pathogenesis of lactate level elevation is provided followed by an in-depth look at the varied etiologies, including medication-related causes, as well as some general recommendations on the management of patients with elevated lactate levels.Abstract:
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.read more
Citations
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Randomized, Double-Blind, Placebo-Controlled Trial of Thiamine as a Metabolic Resuscitator in Septic Shock: A Pilot Study.
Michael W. Donnino,Lars W. Andersen,Maureen Chase,Katherine Berg,Mark Tidswell,Tyler Giberson,Richard E. Wolfe,Ari Moskowitz,Howard A. Smithline,Long Ngo,Michael N. Cocchi +10 more
TL;DR: Administration of thiamine did not improve lactate levels or other outcomes in the overall group of patients with septic shock and elevated lactate and a statistically significant decrease in mortality over time was not found.
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Carbon nanomaterials and their application to electrochemical sensors: A review
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Epidemiology, pathophysiology and contemporary management of cardiogenic shock - a position statement from the Heart Failure Association of the European Society of Cardiology
Ovidiu Chioncel,John Parissis,Alexandre Mebazaa,Holger Thiele,Steffen Desch,Johann Bauersachs,Veli-Pekka Harjola,Elena-Laura Antohi,Mattia Arrigo,Tuvia Ben Gal,Tuvia Ben Gal,Jelena Celutkiene,Sean P. Collins,Daniel DeBacker,Vlad Anton Iliescu,Ewa A. Jankowska,Tiny Jaarsma,Tiny Jaarsma,Kalliopi Keramida,Mitja Lainscak,Lars H. Lund,Lars H. Lund,Alexander R. Lyon,Josep Masip,Josep Masip,Marco Metra,Òscar Miró,Andrea Mortara,Christian Mueller,Wilfried Mullens,Maria Nikolaou,Massimo F Piepoli,Susana Price,Giuseppe M.C. Rosano,Antoine Vieillard-Baron,Jean Mark Weinstein,Stefan D. Anker,Gerasimos Filippatos,Gerasimos Filippatos,Frank Ruschitzka,Andrew J.S. Coats,Petar M. Seferovic,Petar M. Seferovic +42 more
TL;DR: The goal of this review is to summarize the current knowledge concerning the definition, epidemiology, underlying causes, pathophysiology and management of CS based on important lessons from clinical trials and registries, with a focus on improving in‐hospital management.
Journal ArticleDOI
Excess Lactate: An Index of Reversibility of Shock in Human Patients.
TL;DR: "Excess lactate," an indicator of oxygen debt, has been studied as a metabolic index of severity of the shock state in human patients and serves as an objective clinical guide for measurement of "reversibility".
Serum Lactate and Base Deficit as Predictors of Mortality in Normotensive Elderly Blunt Trauma Patients
TL;DR: Both lactate and BD were associated with significantly increased mortality in normotensive elderly blunt trauma patients and, because of the high baseline mortality rates in elderly trauma patients, "normal" lactate does not offer complete reassurance to the clinician.
References
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Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock
Emanuel P. Rivers,Bryant Nguyen,Suzanne Havstad,Julie Ressler,Alexandria Muzzin,Bernhard P. Knoblich,Edward L. Peterson,Michael C. Tomlanovich +7 more
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Journal ArticleDOI
Early lactate clearance is associated with improved outcome in severe sepsis and septic shock.
H. Bryant Nguyen,Emanuel P. Rivers,Bernhard P. Knoblich,Gordon Jacobsen,Alexandria Muzzin,Julie Ressler,Michael C. Tomlanovich +6 more
TL;DR: Lactate clearance early in the hospital course may indicate a resolution of global tissue hypoxia and is associated with decreased mortality rate, and patients with higher lactate clearance after 6 hrs of emergency department intervention have improved outcome compared with those with lower lactate cleared.
Early Lactate Clearance is Associated with Improved Outcome in Severe Sepsis and Septic Shock Early Lactate Clearance is Associated with Improved Outcome in Severe Sepsis and Septic Shock
TL;DR: In this paper, the authors examined the effect of lactate clearance during the initial phase of sepsis and prior to ICU admission and found that a high clearance in the first 6 hours of presentation was associated with a decreased mortality rate.
Journal ArticleDOI
Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy: A Randomized Clinical Trial
Alan E. Jones,Nathan I. Shapiro,Stephen Trzeciak,Ryan C. Arnold,Heather A. Claremont,Jeffrey A. Kline +5 more
TL;DR: Test the hypothesis of noninferiority between lactate clearance and central venous oxygen saturation (ScvO2) as goals of early sepsis resuscitation and found that among patients with septic shock who were treated to normalizeCentral venous and mean arterial pressure, additional management tonormalize lactate cleared did not result in significantly different in-hospital mortality.
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