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Continuing Education in Anaesthesia, Critical Care & Pain 2006 6(3):128-132; doi:10.1093/bjaceaccp/mkl018
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Continuing Education in Anaesthesia, Critical Care & Pain | Volume 6 Number 3 2006 © The Board of Management and Trustees of the British Journal of Anaesthesia [2006]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Lactate physiology in health and disease

Barrie Phypers, FRCA and JM Tom Pierce, MRCP FRCA
Specialist Registrar in Anaesthesia, Shackleton Department of Anaesthesia, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
Consultant Cardiac Anaesthetist, Shackleton Department of Anaesthesia, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK Tel: 023 80796135 Fax: 023 80794348 E-mail: tom.pierce@suht.swest.nhs.uk (for correspondence)
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Key points

Blood lactate concentrations reflect the balance between lactate production and clearance.

Glycolysis, gluconeogenesis and pyruvate conversion to and from lactate are linked with NAD+ and NADH.

Failure of oxidative mechanisms can affect both production and clearance of lactate.

Lactate concentrations >5 mmol litre–1 with severe metabolic acidosis predicts high mortality.

Impaired lactate clearance, rather than hypoxic tissue production of lactate, is the cause of hyperlactaemia in stable septic patients.

 

The normal plasma lactate concentration is 0.3–1.3 mmol litre–1. Considered once as a special investigation, it is increasingly measured automatically with the blood gas analysis. Plasma concentrations represent a balance between lactate production and lactate metabolism. In humans, lactate exists in the levorotatory isoform.


   Normal lactate production
 
Glycolysis in the cytoplasm produces the intermediate metabolite pyruvate (Fig. 1). Under aerobic conditions, pyruvate is converted to acetyl CoA to enter the Kreb's cycle. Under anaerobic conditions, pyruvate is converted by . . . [Full Text of this Article]


   Measurement of lactate
 

   Lactate and lactic acidosis
 

   NADH and NAD+
 

   Normal lactate metabolism
 

   Causes of hyperlactaemia
 
Increased lactate production

Increased glycolysis

Errors of metabolism

Decreased hepatic lactate clearance

Oral hypoglycaemic drugs

Hartmann's solution

Sepsis

Chronic disease

Decreased extra hepatic metabolism

Reduced renal excretion


   Lactate and critical illness
 
Cardiac arrest and resuscitation

Sepsis

Intestinal infarction


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