Why are Lactic Acid Levels Elevated in Sepsis Patients?

Instructor: Tara Schickel

Tara has taught staff nursing courses and has a master's degree in public health.

This article will describe what information a lactate level provides, and why it is important to know lactate levels in sepsis patients. You will also learn what increasing and decreasing lactate levels mean for this patient population.

Why Is My Husband's Lactate Level Rising?

Betty is at her husband's bedside in the Intensive Care Unit (ICU) at Brook Hospital. He was admitted to the ICU this morning with a diagnosis of sepsis, a potentially deadly condition caused by infection. The nurse just came in the room and told her that her husband has an elevated lactate level, and it just keeps going up. The staff seem alarmed by this, but Betty is unsure why. When she asks the nurse what this means, she is informed that lactate levels begin to rise when blood flow decreases. It is a sign of impaired tissue perfusion. Impaired tissue perfusion occurs when the body tissues don't get the blood supply they need. Since blood carries oxygen to the tissues, a lack of blood flow also indicates a lack of oxygen.

Betty learns that elevated lactate levels let the staff know that the correct supply of oxygen needed by tissues in the body isn't getting there. The lack of enough oxygen in the tissues results in an increase in the production of lactate. Lactate crosses into the bloodstream at the cellular level and shows up as a lactate level in the blood. The nurse is truthful with Betty and explains to her that they are worried because when lactate levels increase, the chance of the patient dying increases. If they can provide treatment and get the lactate levels to decrease, the risk of death also decreases.

Understanding the Severity

After a long discussion with the nurse, Betty now understands the seriousness of elevated lactate levels. She knows that a rising lactate level reflects the lack of oxygen supply to the body's tissues. If the body tissues don't get the oxygen they need, this is called tissue hypoxia. Tissue hypoxia is a problem because it can lead to cell death and organ failure.

With a Diagnosis of Sepsis, How Important Are Lactate Levels?

The nurse talks to Betty and explains that they have to keep a close watch on her husband's blood pressure. However, watching his lactate levels is just as important as watching his blood pressure. A patient's lactate levels can give as much information about the severity of sepsis as blood pressure can. Current evidence-based medicine uses specific criteria for physicians to diagnose a progression from severe sepsis to septic shock. If the patient's blood pressure remains low (under 90mmHg) despite attempts at fluid resuscitation, and the lactate level is 2mmol/L or higher, the criteria is met to diagnose the patient to be in septic shock. Septic shock is a worse level of sepsis. The risk of mortality is high.

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