Abstract
Measurements of blood lactate levels can be very useful for detecting the presence of tissue underperfusion and for guiding therapy. Increased blood lactate levels usually reflect an imbalance between the oxygen demand and the oxygen supply to the cells, but other conditions may also be responsible. The present chapter first reviews the biochemistry of blood lactate, then reviews the clinical conditions associated with hyperlactatemia and finally discusses some therapeutic implications.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Similar content being viewed by others
References
Zhang H, Vincent JL (1993) Arteriovenous differences in PCO2 and pH are good indicators of critical hypoperfusion. Am Rev Respir Dis 148:867–871
Iberti TJ, Leibowitz AB, Papadakos PJ et al (1990) Low sensitivity of the anion gap as a screen to detect hyperlactatemia in critically ill patients. Crit Care Med 18:275–277
Poortmans JR, Bossche JD, Leclercq R (1978) Lactate uptake by inactive forearm during progressive leg exercise. J Appl Pysiol 45:835–839
Freyschuss U, Strandell T (1967) Limb circulation during arm and leg exercise in supine position. J Appl Physiol 23:163–170
Watt PW, MacLennan PA, Hundai HS et al (1988) L(+)-Lactate transport in perfused rat skeletal muscle: kinetic characteristics and sensitivity to pH and transport inhibitors. Biochem Biophys Acta 944:213–222
Graham TE, Barclay JK, Wilson BA (1986) Skeletal muscle lactate release and glycolytic intermediates during hypercapnia. J Appl Physiol 60:568–575
Gutierrez G, Hurtado FJ, Gutierrez AM et al (1993) Net uptake of lactate by rabbit hindlimb during hypoxia. Am Rev Respir Dis 148:1204–1209
Hurtado FJ, Gutierrez AM, Silva R et al (1992) Role of tissue hypoxia as the mechanism of lactic acidosis during E. coh endotoxemia. J Appl Physiol 72:1895–1901
Vary TC, Siegel JH, Nakatani T et al (1986) Effect of sepsis on activity of pyruvate dehydrogenase complex in skeletal muscle and liver. Am J Physiol 250:E634-E640
Preiser JC, Moulart D, Vincent JL (1990) Dichloroacetate administration in the treatment of endotoxin shock. Circ Shock 30:221–228
Curtis SE, Cain SM (1992) Regional and systemic oxygen delivery/uptake relations and lactate flux in hyperdynamic endotoxin treated dogs. Am Rev Respir Dis 145:348–354
Stacpoole PW, Wright EC, Baumgartner TG et al (1994) Natural history and course of acquired lactic acidosis in adults. Am J Med 97:47–54
Mela LM, Miller LD, Nicholas GG (1972) Influence of cellular acidosis and altered cation concentrations on shock-induced mitochondrial damage. Surgery 72:102–110
Vitek V, Cowley RA (1971) Blood lactate in the prognosis of various forms of shock. Ann Surg 173:308–313
Rosenberg JC, Rush BE (1986) Blood lactic acid levels in irreversible haemorrhagic and lethal endotoxin shock. Surg Gynecol Obstet 126:1247–1250
Vincent JL, Dufaye P, Berre J et al (1983) Serial lactate determinations during circulatory shock. Crit Care Med 11:449–451
Haupt MT, Gilbert EM, Carlson RW (1985) Fluid loading increases oxygen consumption in septic patients with lactic acidosis. Am Rev Respir Dis 131:912–916
Gilbert EM, Haupt MT, Mandanas RY et al (1986) The effect of fluid loading, blood transfusion and catecholamine infusion on oxygen delivery and consumption in patients with sepsis. Am Rev Respir Dis 134:873–878
Vincent JL, Roman A, DeBacker D et al (1990) Oxygen uptake/supply dependency: effects of short-term dobutamine infusion. Am Rev Respir Dis 142:2–8
Fellows IW, Bennett T, Macdonald IA (1985) The effect of adrenaline upon cardiovascular and metabolic functions in man. Clin Sci 69:215–222
Annat G, Viale JP, Percival C et al (1986) Oxygen delivery and uptake in the adult respiratory distress syndrome: lack of relationship when measured independently in patients with normal blood lactate concentrations. Am Rev Respir Dis 133:999–1001
Kruse JA, Zaidi SA, Carlson RW (1987) Significance of blood lactate levels in critically ill patients with liver disease. Am J Med 83:77–82
Peretz DI, McGregor M, Dossetur JB (1964) Lactic acidosis: a chnically significant aspect of shock. Can Med Assoc J 90:673–675
Peretz DI, Scott HM, Duff J et al (1965) The significance of lactacidemia in the shock syndrome. Ann NY Acad Sci 119:1133–1141
Weil MH, Afifi A A (1970) Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation 41:989–1001
Bakker J, Leon M, Coffemils M et al (1992) Serial blood lactate levels can predict multiple organ failure in septic shock patients. Crit Care Med 20:S56 (abstr)
Aduen J, Bernstein WK, Khastgir T et al (1994) The use and clinical importance of a substrate-specific electrode for rapid determination of blood lactate concentrations. JAMA 272:1678–1685
Bakker J, Coffemils M, Leon M et al (1991) Blood lactate levels are superior to oxygen derived variables in predicting outcome in human septic shock. Chest 99:956–962
Bakker J, Gris P, Coffemils M et al (1995) Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg (in press)
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1996 Springer-Verlag Italia, Milano
About this chapter
Cite this chapter
Vincent, JL. (1996). Lactic Acidosis: Diagnosis and Treatment. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-2203-4_3
Download citation
DOI: https://doi.org/10.1007/978-88-470-2203-4_3
Publisher Name: Springer, Milano
Print ISBN: 978-3-540-75014-7
Online ISBN: 978-88-470-2203-4
eBook Packages: Springer Book Archive