Podcast 819: Indiscriminate Lactate Testing

Contributor: Jared Scott, MD

Educational Pearls:

• Elevated lactate levels can be a useful indicator of critical illness in patients who meet SIRS criteria
• Lactate can also be elevated due to other causes including seizures and medications such as albuterol and metformin
• A recent study from Switzerland* performed routine point-of-care lactate testing in all elderly patients presenting at triage in the emergency department in order to determine the prevalence of elevated lactate in the population and its utility in predicting poor patient outcomes
• Patients with seizure as their chief complaint were excluded from the study due to expected transient elevated lactate levels
• Poor outcomes were defined as requiring extensive IVF and/orvasoactive medications, undergoing intubation, admission to the ICU, or death
• 27.1% of patients had an increased lactate but only 7.3% actually met poor outcome criteria
• ED physicians should note that an increased lactate in an elderly patient does not mean that they are critically ill
• Routine point-of-care lactate monitoring at triage is of limited usefulness and should instead be targeted towards those who meet critical illness criteria

*Errata: This study was performed in Switzerland, not Sweden as was stated in the podcast

References

Gosselin M, Mabire C, Pasquier M, et al. Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study. Intern Emerg Med. 2022;17(6):1803-1812.

Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD

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