Tissue Lactate Concentrations in Critical Illness

  • B. Venkatesh
  • T. J. Morgan


Perturbations in oxygen delivery to, and consumption by, the tissues are common in critical illness resulting in impaired tissue metabolism. This in turn can result in biochemical changes, which if uncorrected may progress to cell death. Lactic acidosis is a signal of tissue distress associated with altered tissue perfusion and cell metabolism [1, 2]. This is evidenced by the demonstration of high lactate concentrations in the setting of shock and circulatory failure, irrespective of the aetiology [3]. There are also data to show that elevated blood lactate concentrations in critical illness portend a poor prognosis [4–8]. Not surprisingly, arterial plasma lactate measurements have become commonplace in intensive care. However, a number of caveats need to be applied when interpreting plasma lactate concentrations. Certain clinical situations might reduce the sensitivity of plasma lactate concentrations as an indicator of dysoxia (oxygen limited cytochrome turnover) [9]. This might result if regional production of lactate in ischemic tissues was diluted by venous effluent from well perfused tissues or if the liver, kidney and possibly the muscle tissue acted as efficient ‘sinks’ for the lactate and prevented significant elevations in the plasma [10–12]. Conversely, an elevation in plasma lactate concentration might not always signify dysoxia, thus reducing its specificity. Hyperlactatemia without dysoxia might result from aerobic glycolysis during sepsis, liver failure, altered pyruvate dehydrogenase activity, hyperventilation, elevated catecholamine concentrations and in the presence of certain drugs and toxins [13–15].


Critical Illness Lactate Concentration Lactic Acidosis Lactate Production Plasma Lactate Concentration 
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© Springer Science+Business Media New York 2002

Authors and Affiliations

  • B. Venkatesh
  • T. J. Morgan

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