Friday November 11, 2005
Regarding Lactate level

It is worth to continue to emphasize to house staff that:

1. if feasible 'arterial' lactate is preferable to venous lactate as it get influenced with time and pressure of tourniquet.

2. Lactate level is under-utilized blood workup in sepsis patients. Its not a perfect analogy but as CPK and MB is to chest pain, WBC (Leucocytosis) and lactate level is to sepsis. (We are still in search of troponin of sepsis!).

3. Time matters exactly same in septic attack as in heart attack and brain attack. Lactate level (even venous) can help tremendously in identifying this attack early when hemodynamic is still relatively stable.

See Rivers early goal directed therapy's algorithm. - (NEJM) where lactate level of 4 has been used as cutoff point to start algorithm.

References: Click on link to get abstract/article:
1.Changes in venous blood lactate, venous blood gases, and somatosensory evoked potentials after tourniquet application - Anesthesiology. 1988 Nov;69(5):677-82
2. Early Goal-directed Therapy in the Treatment of Severe Sepsis and Septic Shock - November 2001, NEJM