1/ During team rounds , a series of lactate levels resulted in the response to throw more salt water at the situation to see if Lactate reaches <2mmol/L. This called for a intensive review into why Lactate can in relatively stable patients.
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2/The most common causes of hyperlactatemia are usually;
-hypoxemia
-tissue hypoperfusion
-toxic-induced impairment of cellular metabolism,
-regional ischemia or the mechanism is unknown
Many other causes are listed as Type A and B categories
#Hyperlactatemia

3/ Lactate levels depend on
-ongoing production
-removal from the blood by excretion (e.g., urine, sweat) -its metabolism (e.g., uptake by cells as a direct source of energy, conversion to glucose by the liver)

4/Why do we emphasize this parameterThe use of lactate as a clinical prognostic tool was suggested in 1964 by Broder and Weil - they observed that a lactate excess of > 4 mmol/L was associated with poor outcomes in patients with undifferentiated shock. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3975915/

5/Therefore, time and time again we might see an urgency to bolus these values as we somehow equate that an elevated lactate means the patient is in impending shock.

6/What we should be teaching is that elevated lactate is encountered in a multitude of clinical presentations and disease states one of which is the critically ill patient with shock/hypoxemia/Sepsis etc.
Persistent hyperlactatemia is particularly difficult to interpret.

7/Causes of elevated lactate apart from tissue hypoperfusion have been recognized and should be considered in the appropriate clinical context.
One of these is the contribution of liver or renal injury in the production and clearance of Lactate.
Both of these organs canlactate

8/With Lactate, our response should be
to determine the underlying cause.
-hypoperfusion/ hypoxemia -> focus on improving perfusion
-shock->treatments include fluid administration, vasopressors, or inotropes.
->regional ischemia, surgery may be needed to restore circulation

9/-If drugs, seizures, malignancy, or thiamine deficiency are the cause
-stop
-reverse
-and treat the offending agent.

10/Multiple conditions can contribute to lactic acidosis, therefore carefully;
-evaluate the patient’s complete medical history
-conduct a thorough physical assessment
-assess other laboratory or diagnostic tests before beginning treatment.
Join the resistance simpy to bolus !