Tuesday, February 4, 2020

Lactate Levels cannot be corrected by Giving More Oxygen

I have covered lactate quite thoroughly over the last couple weeks but I still receive comments and questions from followers talking about oxygen deficiency to the cell causing elevated lactate and lactic acidosis. They ask "why don't you just increase the O2 that you're providing to the patient to help the cells out"? This question is not out of line with traditional thinking behind lactic acidosis being the byproduct of "tissue hypoxia" which I hope at this point you understand is NOT the cause of elevated lactate levels in septic shock patients (see many other posts for further details).

This study published in JAMA in 1993. The three key findings of their work include:

1. Critical O2 delivery was identified and is considerably lower than previously estimated. Increasing O2 delivery to supra-normal levels in critically ill patients in the hope of increasing O2 consumption may be inappropriate.

2. Sepsis was not associated with an increased critical O2 delivery

3. The increased concentration of arterial lactate at baseline was not associated with global tissue hypoxia, suggesting that lactate may not be a specific marker of tissue hypoxia in critically ill patients.

Hope this helps! A hat tip to the authors!

- EJ

Link to Article

Ronco JJ, Fenwick JC, Tweeddale MG, et al. Identification of the Critical Oxygen Delivery for Anaerobic Metabolism in Critically III Septic and Nonseptic Humans. JAMA. 1993;270(14):1724–1730.

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