Résumé
Le lactate est un substrat issu de la glycolyse qui peut s’accumuler en cas d’excès de production ou de défaut de sa clairance métabolique. Sa concentration plasmatique est normalement inférieure à 2 mmol/l et sa demi-vie normale est brève, inférieure à dix minutes. On observe une élévation du taux plasmatique de lactate au cours de situations cliniques associées à une hypoxie tissulaire absolue (états de choc, hypoxémie profonde, ischémie, etc.) ou relative (exercice intense, convulsions, hyperthermie maligne) mais aussi au cours de situations sans hypoxie tissulaire évidente (sepsis, anomalie métabolique, insuffisance hépatique terminale). Lorsque l’hyperlactatémie est importante, supérieure à 5 mmol/l, et qu’elle s’accompagne d’une acidose métabolique, on parle alors d’acidose lactique. L’existence d’une élévation du taux de lactate plasmatique est un indicateur de gravité au cours de nombreuses pathologies aiguës et incite à une prise en charge intensive du patient. Ainsi, la mesure systématique de la lactatémie au cours de la phase de triage de certaines pathologies telles que le sepsis ou les traumatismes sévères permet de détecter précocement les patients nécessitant une prise en charge rapide et spécifique. De plus, la surveillance répétée de la lactatémie réalise un véritable monitorage biologique de l’efficacité du traitement initial de l’insuffisance circulatoire aiguë. La possibilité de disposer d’appareils de mesure délocalisés permettant de mesurer la lactatémie de façon fiable sur des microéchantillons de sang total rend cette mesure encore plus attractive en situation de triage ou d’urgence vitale. Enfin, la mesure du taux de lactate dans le liquide céphalorachidien (LCR) au cours des méningites aiguës est sans doute un des meilleurs indicateurs pour différencier précocement les infections bactériennes des infections méningées virales.
Abstract
Lactate is an end product of glycolysis that may accumulate in case of excess production of lactate or failure of its metabolic clearance. Normal plasma concentration of lactate is less than 2 mmol/l and its normal half-life is short, less than 10 mins. There is a rise in plasma lactate during clinical situations associated with tissue hypoxia, which may be absolute (shock state, deep hypoxemia, ischemia, etc.) or relative (strenuous exercise, seizures, malignant hyperthermia), but also under conditions without obvious tissue hypoxia (sepsis, metabolic abnormalities, terminal hepatic failure). Lactic acidosis is defined as a metabolic acidosis explained by a blood lactate concentration greater than 5 mmol/l. The presence of hyperlactatemia is an indicator of severity in many diseases and should prompt the physician to provide immediate care for the patient. Thus, routine measurement of blood lactate during the screening stage of some diseases such as sepsis or severe trauma allows early detection of patients requiring a rapid and specific response. Moreover, repeated measurement of blood lactate make a real biological monitoring of the effectiveness of initial treatment of acute circulatory failure. Some pointof- care reliable lactate measurement can be made in the emergency department using microsamples of whole blood makes this measure more feasible during triage or lifethreatening situations. At last, the measurement of lactate levels in CSF during acute meningitis is probably one of the best indicators to distinguish early bacterial infections from viral meningitis.
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Levraut, J., Lemoël, F. & Leplatois, T. Intérêt du dosage du lactate en médecine d’urgence. Ann. Fr. Med. Urgence 1, 185–191 (2011). https://doi.org/10.1007/s13341-011-0038-z
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DOI: https://doi.org/10.1007/s13341-011-0038-z