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Pitfalls in Lactate Interpretation
- Lactate is one of the most common biomarkers used in critical care.
- While an elevated lactate level is often attributed to impaired tissue oxygenation, an important pitfall in lactate interpretation in the critically ill is the failure to consider non-hypoxic causes of increased levels. These include:
- Enhanced glycolysis (B2-agonist administration, increased metabolic activity)
- Reduced clearance (hepatic failure, renal dysfunction, muscular dysfunction)
- Impaired tissue metabolism (mitochondrial dysfunction due to drug intoxication)
- Additional pitfalls in lactate use in the critically ill include:
- Use of an isolated value rather than assessing longitudinal trends
- Failure to correlate elevated lactate levels with other markers of perfusion (i.e., capillary refill time)
- Use of rigid normalization targets rather than targeting therapeutic interventions to the full clinical picture
References
Levy B, et al. Lactate dynamics as a marker of perfusion: physiological interpretation and pitfalls. Intensive Care Med. 2025; 51:2145-8.