Podcast 819: Indiscriminate Lactate Testing

<p><strong>Contributor: Jared Scott, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Elevated lactate levels can be a useful indicator of critical illness in patients who meet SIRS criteri</span><span style="font-weight: 400;">a</span><span style= "font-weight: 400;">       </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Lactate can also be elevated due to other causes including seizures and medications such as albuterol and metformin</span><span style= "font-weight: 400;">  </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">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</span></li> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;"> </span><span style= "font-weight: 400;">Patients with seizure as their chief complaint were excluded from the study due to expected transient elevated lactate levels</span></li> </ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Poor outcomes were defined as requiring extensive IVF and/orvasoactive medications, undergoing intubation, admission to the ICU, or death</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">27.1% of patients had an increased lactate but only 7.3% actually met poor outcome criteria</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">ED physicians should note that an increased lactate in an elderly patient does not mean that they are critically ill</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Routine point-of-care lactate monitoring at triage is of limited usefulness and sho