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Lactate – the most objective marker of “shock”

Lactate – the most objective marker of “shock”. In anaerobic conditions, pyruvate does not enter TCA (Krebs) cycle but is converted to lactate Lactate diffuses rapidly out of cell and can be measured in systemic circulation. Restoration of perfusion.

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Lactate – the most objective marker of “shock”

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  1. Lactate – the most objective marker of “shock” • In anaerobic conditions, pyruvate does not enter TCA (Krebs) cycle but is converted to lactate • Lactate diffuses rapidly out of cell and can be measured in systemic circulation

  2. Restoration of perfusion • As perfusion is restored, lactate is metabolised in liver with regeneration of glucose (Cori cycle) • Rapid process • Lactate provides “real-time” marker of perfusion status

  3. Has been recognised as a prognostic marker in people since 1970’s Experimental and clinical studies on lactate and pyruvateas indicators of the severity of acute circulatory failure Circulation 41: 989, 1970

  4. Lactate interpretation • Objective measure of severity of “shock” • Change in lactate following therapy may be more prognostically useful than a single lactate measurement {Amanda has seen a living dog with a lactate of 17.3 but it was dead soon after ....anything over 12 is very very bad}

  5. Clinical use of lactate • Serial measurements invariably preferable to single point measurement • Pre and post fluid bolus – how effective has your treatment been? • Ideally normalise or near normalise lactate pre-GA/sedation • To confirm if hypoperfusion present if unsure • Tachycardic RTA – is it early shock/is it pain?

  6. Red herrings....... • Lactate will be high but not represent hypoperfusion in.... • Animals which have had a recent seizure • Immediately post-exercise • Animals that are trembling a lot • Some other VERY uncommon scenarios • Very severe anaemia • Some neoplasia • Rare drugs/toxins

  7. Lactate....a really useful tool • Pricing set up to encourage monitoring of trends • Much more valuable than single measures • Consider as part of baseline in all critically ill admissions • As with all tests, care not to over interpret if the patient physical exam tells you differently

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