Appropriate Clinical Use of Lactate Measurements

Blood lactate measurements have a longstanding history in clinical medicine to assess both disease severity in critical illness and the response to therapeutic interventions. Lactic acid was first discovered in sour milk in 1780 by Swedish pharmacist Carl Wilhelm Scheele and identified in blood during shock by the German physician Johann Joseph Scherer in 1843.¹  Early studies, summarized by Schuster,²  demonstrated the value of assessing lactate in critically ill patients. A meta-analysis of more than 150 reports on lactate concluded that lactate concentrations are important in risk stratification in critically ill patients and a potential endpoint for resuscitation.³  Because lactate is a product of anaerobic metabolism, it is broadly considered as an indicator of tissue hypoxia. However, hyperlactatemia can occur without hypoxia such as in adrenergic states and due to the administration of ß...