Cite this post as:
Scott Weingart, MD FCCM. EMCrit Podcast 37 – Lactate in Sepsis. EMCrit Blog. Published on December 20, 2010. Accessed on June 10th 2023. Available at [https://emcrit.org/emcrit/lactate/ ].
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
Original Release: December 20, 2010
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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A listener writes in: Great post !! While I listend to the podcast, I thought of Metformin as an often quoted cause for high lactate levels/acidosis. So I pulled up a Cochrane Review (Pubmed ID: 20393934). According to which: “Average lactate levels measured during metformin treatment were no different than for placebo or for other medications used to treat diabetes. In summary, there is no evidence at present that metformin is associated with an increased risk for lactic acidosis when prescribed under the study conditions.” So no baseline change in lactate in patients on M. But what about patients on… Read more »
Intriguing thought. I have never seen any lit showing metformin in normal doses should alter the accuracy of lactate for sepsis. Overdose is a different story.
Stupid question, I know, so I apologise in advance, but when you refer to the “show notes” on the podcast, is this just the entry here (on which I’m commenting), and which appears on my iPod? Or are there notes elsewhere?
Sorry to be so dim, buty I often hear you talking about references in the handout/shownotes etc., and am never quite sure where I should be looking.
It is a great question because I forgot to put the reference sheet up. It is here now. Show notes refer to the blog post that goes with each episode. So you went to the right place and the reason you could not find it is I had completely forgotten.
I was thinking in particular of the refs for venous vs arterial lactate, which I can’t seem to find. I’m not usre if this is me, the work computer and it’s odd access policies denying me a look at some pages, or something else.
Thanks for the help!
The lactate reference sheet was excellent!
glad you liked it, Fred
Great podcast on lactate. However two lurking questions remain.
Firstly, what happened to the intro music?
Secondly, carrying the notion of the elderly not being able to generate super high lactates secondary to poor catchecolamine reserve, what about the patient that is on beta blockade.
intro music will come back in 2011
your intuition regarding beta blockade is dead-on I think,
some data supports this, such as
however, I have no advice on how to lower the lactate cut-off in these pts to account for their beta-blockers
The Lactate FAQ is great, but a nurse asked me if my Lactated Ringer’s (28mEq/L) can cause a false positive. Any knowledge on that?
In pts with a normal liver, ~100 meq / hour is cleared, so in these patients no. In the cirrhotic, yes it may accumulate.
Lactate- is anion (base).. so, why does it cause acidosis?
Anions (neg charge) make you ACIDIC.
I know it’s a basic knowledge but it’s confusing.. do you mean that a base can be either negative or positive charged?
Take a look at a tutorial on Peter Stewart’s Acid-Base which should make your understanding much more physiological (yes, like all of us, you have been taught many lies…)
I am going to give a talk regarding lactate as biomarker in sepsis on September 3rd. However, I found this article that raises serious concerns on the application of lactate clearance in sepsis management.
Marik PE, Bellomo R, Demla V. Lactate clearance as a target of therapy in sepsis: a flawed paradigm. OA Critical Care 2013 Mar 01;1(1):3.
Are you aware of it? Any comments?
yes, did a wee on it. there was nothing in that article that in any way affects the use of lactate for sepsis management.
Probably a stupid question from a medical student, but if you have a septic patients being treated with inotropes, how do you know whether the lactate is from the drups or from hypo perfusion? Thanks in advance.
Iionotropes as far I know won’t increase lactate significantly, you see that more with epinephrine which is more of a pressor, and that too only at higher doses. Basically if all other variables are improving, like MAP, urine output, CO etc. then lactate even if elevated should be down trending and that’s all that matters.
lactate increase is from beta stimulation. has nothing to do with alpha/pressor effects of epi. you will see this phenomenon even more commonly with agents like albuterol that are pure beta.
Mehdi Monfared Emergency Doc from Australia, NSW A couple of days ago, when I was seeing a very sick and septic patient, as soon as the nurse told me her lactate was 18.0, it reminded me of this lovely lecture Scott. Straight away I knew she was not going to do well, regardless of the cause. Later we realised she had severe sepsis with multiple organ failure and also bone marrow failure. Scott I just wanted to mention your tip helped me a lot to first calm myself down, then the nurses and then after the whole blood results we… Read more »