Significance of blood lactate levels in critically III patients with liver disease

Mortality rates associated with severe lactic acidosis (blood pH<7.2) due to sepsis or low-flow states are high. Eliminating the triggering conditions remains the most effective therapy. Although recommended by some, administration of sodium bicarbonate does not improve cardiovascular function or reduce mortality. This failure has been attributed to both reduction in serum calcium concentration and generation of excess carbon dioxide with intracellular acidification. In animal studies, hyperventilation and infusion of calcium during sodium bicarbonate administration improves cardiovascular function, suggesting that this approach could allow expression of the positive aspects of sodium bicarbonate. Other buffers, such as THAM or Carbicarb, or dialysis might also provide base with fewer untoward effects. Examination of these therapies in humans is warranted. The cellular injury associated with lactic acidosis is partly due to activation of NHE1, a cell-membrane Na(+)/H(+) exchanger. In animal studies, selective NHE1 inhibitors improve cardiovascular function, ameliorate lactic acidosis, and reduce mortality, supporting future research into their possible use in humans. Two main mechanisms contribute to lactic acid accumulation in sepsis and low-flow states: tissue hypoxia and epinephrine-induced stimulation of aerobic glycolysis. Targeting these mechanisms could allow for more specific therapy. This Acid-Base and Electrolyte Teaching Case presents a patient with acute lactic acidosis and describes current and future approaches to treatment.

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“…However, chronic liver disease alone causes only minimal hyperlactatemia. 48,49 Kidney failure adds to the impairment in lactate clearance.…”

Section: Discussionmentioning

confidence: 99%

Lactic Acidosis: Current Treatments and Future Directions

Kraut

Madias

2016

American Journal of Kidney Diseases

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“…2 The blood lactate concentrations in critically ill and injured adult patients can be used to detect tissue hypoxia at an early stage, assess illness severity, and predict outcome. 3,4 Recent papers have drawn our attention to the prognostic value of lactacidaemia in newborns with severe hypoxaemia. 2,5 The relationship between intrapartum asphyxia and neurological abnormalities is controversial.…”

Section: Introductionmentioning

confidence: 99%

Postnatal Lactate as an Early Predictor of Short-Term Outcome after Intrapartum Asphyxia

2003

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OBJECTIVES:To compare the predictive value of pH, base deficit and lactate for the occurrence of moderate-to-severe hypoxic ischaemic encephalopathy (HIE) and systemic complications of asphyxia in term infants with intrapartum asphyxia. STUDY DESIGN:We retrospectively reviewed the records of 61 full-term neonates (Z37 weeks gestation) suspected of having suffered from a significant degree of intrapartum asphyxia from a period of January 1997 to December 2001.The clinical signs of HIE, if any, were categorized using Sarnat and Sarnat classification as mild (stage 1), moderate (stage 2) or severe (stage 3). Base deficit, pH and plasma lactate levels were measured from indwelling arterial catheters within 1 hour after birth and thereafter alongwith every blood gas measurement. The results were correlated with the subsequent presence or absence of moderate-to-severe HIE by computing receiver operating characteristic curves. RESULTS:The initial lactate levels were significantly higher (p ¼ 0.001) in neonates with moderate-to-severe HIE (mean±SD ¼ 11.09±4.6) as compared to those with mild or no HIE (mean±SD ¼ 7.1±4.7). Also, the lactate levels took longer to normalize in these babies. A plasma lactate concentration >7.5±mmol/l was associated with moderate-or-severe HIE with a sensitivity of 94% and specificity of 67%. The sensitivity and negative predictive value of lactate was greater than that of the pH or base deficit. CONCLUSIONS:The highest recorded lactate level in the first hour of life and serial measurements of lactate are important predictors of moderate-to-severe HIE.

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“…Monitoring of lactate levels seems helpful for assessing the effectiveness of therapy and patient prognosis in several clinical situations, such as cardiogenic shock or septic shock [4][5][6][7]. A persistent elevated arterial lactate level is often associated with a poor prognosis [5].…”

Section: Introductionmentioning

confidence: 99%