ISSN 2398-2950      

Lactate measurement

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Introduction

  • Generation of lactate by anaerobic metabolic processes and its subsequent quantitative assessment allows evaluation of the presence and severity of tissue hypoperfusion.
  • Lactate measurement in cavitary effusions can also be diagnostically valuable.
  • Recent developments in point-of-care laboratory testing have allowed more rapid assessment of patient lactate status and increased its clinical usefulness.

Definitions

  • Hyperlactatemia = higher than normal blood lactate concentration.
  • Acidemia = blood pH < 7.35.
  • Acidosis = a process that on its own will result in a fall in blood pH below 7.35.
  • Lactic acidosis = a state produced when production of lactate exceeds its clearance and results in a fall in pH below 7.35.
  • Normal lactate concentrations in plasma of cats should be <2.5 mmol/L.

Lactate and cellular physiology

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Practical aspects of lactate measurement

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Causes of hyperlactatemia

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Prognostic value of plasma lactate

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Therapy of hyperlactatemia

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Shea E K, Dombrowski S C, Silverstein D C (2017) Survival analysis of hypotensive cats admitted to an intensive care unit with or without hyperlactatemia: 39 cases (2005-2011). JAVMA 250 (8), 887-893 PubMed.
  • Redavid L A, Sharp C R, Mitchell M A et al (2016) Hyperlactatemia and serial lactate measurements in sick cats. J Vet Emerg Crit Care 26 (4), 495-501 PubMed.
  • Reineke E L, Rees C, Drobatz K J (2015) Association of blood lactate concentration with physical perfusion variables, blood pressure, and outcome for cats treated at an emergency service. JAVMA 247 (1), 79-84 PubMed.
  • Pang D S & Boysen S (2007) Lactate in veterinary critical care: pathophysiology and management. JAAHA 43 (5), 270-279 PubMed.
  • Stevenson C K, Kidney B A, Duke T et al (2007) Evaluation of the Accutrend​ for lactate measurement in dogs. Vet Clin Pathol 36 (3), 261-266 PubMed.
  • Rand J S, Kinnaird E, Baglioni A et al (2002) Acute stress hyperglycemia in cats is associated with struggling and increased concentrations of lactate and norepinephrine. J Vet Intern Med 16 (2), 123-132 PubMed.
  • de Papp E, Drobatz K J & Hughes D (1999) Plasma lactate concentration as a predictor of gastric necrosis and survival among dogs with gastric dilatation-volvulus: 102 cases (1995-1998). JAVMA 215 (1), 49-52 PubMed.
  • Hughes D, Rozanski E R, Shofer F S et al (1999) Effect of sampling site, repeated sampling, pH, and PCO2 on plasma lactate concentration in healthy dogs. Am J Vet Res 60 (4), 521-524 PubMed.
  • Lagutchik M S, Ogilvie G K, Hackett T B et al (1998) Increased lactate concentrations in ill and injured dogs. J Vet Emerg & Crit Care (2), 117-127 VetMedResource.
  • Lagutchik M S, Ogilvie G K, Wingfield W E et al (1996) Lactate kinetics in veterinary critical care: a review. J Vet Emerg & Crit Care (2), 81-95 VetMedResource.
  • Mizock B A & Falk J L (1993) Lactic acidosis in critical illness. Crit Care Med 20 (1), 80-93 PubMed.
  • Weil M H & Afifi A A (1970) Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation 41 (6), 989-1001 PubMed.

Other sources of information

  • Silverstein D C & Hopper K (2015) Small Animal Critical Care Medicine. 2nd edn. Elsevier.
  • Trigg N L, McAlees T J (2015) Blood lactate concentration as a prognostic indicator in cats admitted to intensive care. Australian Veterinary Practitioner 45 (1), 17-19.
  • Hughes D (1999) Lactate measurement: diagnostic, therapeutic, and prognostic implications. In: Kirk's Current Veterinary Therapy XIII (ed J D Bonagura) Philadelphia, WB Saunders, pp 112-116.

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