Causes of Elevated Lactate

Author: Michelle Lin, MD
Updated: 12/22/2009

Causes of Elevated Lactate

High lactate levels associated with worse prognosis in medical and trauma patients

  • Level >2 mmol/L is abnormal
  • Level >4 mmol/L suggests tissue hypoperfusion
Pathology Causes

Inadequate
O2 delivery
  • Severe dehydration
  • Blood loss
  • Severe anemia
  • Hypoxemia
  • CO prolonged exposure
  • Trauma

Disproportionate
O2 demand
  • Hyperthermia
  • Shivering
  • Seizure
  • Strenuous exercise

Inadequate
O2 use
SIRS
  • DM
  • TPN
  • HIV infection
  • Medications:
    • Metformin
    • Salicyclate
    • Antiretrovirals
    • INH
    • Propofol
    • Cyanide

    References

    • Strehlow MC.Early identification of shock in critically ill patients. Emerg Med Clin North Am. 2010 Feb;28(1):57-66, vii. doi: 10.1016/j.emc.2009.09.006. [PubMed]
    • Perera P et al. Rapid Ultrasound in SHock in the Evaluation of the Critically lll. EMCNA 2010; 28: 29-56. [PubMed]