Am. J. Respir. Crit. Care Med., Volume 157, Number 4, April 1998, 1021-1026

Mild Hyperlactatemia in Stable Septic Patients Is Due to Impaired Lactate Clearance Rather Than Overproduction

JACQUES LEVRAUT, JEAN-PIERRE CIEBIERA, STEPHANE CHAVE, OLIVIER RABARY, PATRICK JAMBOU, MICHEL CARLES, and DOMINIQUE GRIMAUD

Département d'Anesthésie-Réanimation, Centre Hospitalier Universitaire de Nice, Nice, France

A prospective study was conducted on 34 stable septic patients to determine whether mild hyperlactatemia is a marker of lactate overproduction or an indicator of lactate underutilization during sepsis. Plasma lactate clearance and lactate production were evaluated by modeling the lactate kinetic induced by an infusion of 1 mmol/kg L-lactate over 15 min. The patients were divided in two groups depending on their blood lactate:  1.5 mmol/L (n = 20, lactate = 1.2 ± 0.2 mmol/L) or  2 mmol/L (n = 10, lactate = 2.6 ± 0.6 mmol/L). The hyperlactatemic patients had a lower lactate clearance (473 ± 102 ml/kg/h) than those with normal blood lactate (1,002 ± 284 ml/kg/h, p < 0.001), whereas lactate production in the two groups was similar (1,194 ± 230 and 1,181 ± 325 µmol/kg/h, p = 0.90). A second analysis including all the patients confirmed that the blood lactate concentration was closely linked to the reciprocal of lactate clearance (r² = 0.73, p < 0.001) but not to lactate production (r² = 0.03, p = 0.29). We conclude that a mild hyperlactatemia occurring in a stable septic patient is mainly due to a defect in lactate utilization.

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