Elevated Lactate

An increased blood lactate concentration above the normal range (approximately 0.5-2.0 mmol/L). Elevated lactate indicates increased anaerobic metabolism, impaired oxygen delivery/utilization, or reduced metabolic clearance and may result in lactic acidosis.

Causes

• Tissue hypoperfusion: Type A lactic acidosis

  • Sepsis

  • Shock

  • Cardiac arrest

  • Severe hypoxemia

  • Severe trauma

  • Burns

• Increased lactate production: Type B lactic acidosis

  • Strenuous exercise

  • Diabetic ketoacidosis (DKA)

  • Seizures

  • Toxins: Ethanol, Methanol, Ethylene Glycol, Cyanide, Carbon Monoxide, Salicylate

  • Medications: Metformin, NRTIs, β-2 agonist, propofol, linezolid, valproat, isoniazid, HIV antiretroviral therapy

• Reduced lactate clearance

  • Liver failure

  • Kidney failure

• Mitochondrial diseases

• Malignancy (especially hematologic cancers)