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Ann Emerg Med. 2019 Aug 29. pii: S0196-0644(19)30537-2. doi: 10.1016/j.annemergmed.2019.06.027. [Epub ahead of print]

Demystifying Lactate in the Emergency Department.

Author information

1
Department of Emergency Medicine, University of California at San Diego, San Diego, CA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California at San Diego, San Diego, CA. Electronic address: gwardi@ucsd.edu.
2
Department of Emergency Medicine, University of California at San Diego, San Diego, CA.
3
Department of Emergency Medicine, University of California at San Diego, San Diego, CA; Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, University of California at San Diego, San Diego, CA.

Abstract

The role of lactic acid and its conjugate base, lactate, has evolved during the past decade in the care of patients in the emergency department (ED). A recent national sepsis quality measure has led to increased use of serum lactate in the ED, but many causes for hyperlactatemia exist outside of sepsis. We provide a review of the biology of lactate production and metabolism, the many causes of hyperlactatemia, and evidence on its use as a marker in prognosis and resuscitation. Additionally, we review the evolving role of lactate in sepsis care. We provide recommendations to aid lactate interpretation in the ED and highlight areas for future research.

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