11 - Lactate

Question 1

What is lactate?

Answer 1

A laboratory marker which we use as a tool to determine OXYGEN KINETICS in the body

Question 2

If you see oxygen kinetics on the test?

Answer 2

Its the right answer, just pick it and move on

Question 3

Lactate levels

Answer 3

> 4mml/L have a higher morbidity and mortality

Question 4

What is shock?

Answer 4

HOTN
Tachycarida

But mostly its:
- the bodies inability to keep up with oxygen demand

Question 5

Types of shock?

Answer 5

Hopovalemic - hemorrhagic/cardiogenic
Neurogenic - spinal cord injury/TBI
Vasogenic - SIRS, sepsis, adrenal insuf, septic shock

Question 6

Lactate is a sign that the body has switched from aerobic to anerobic fermentation. What does this mean?

Answer 6

Aerobic
- 1 glucose = 36 ATP

Anaerobic
- 1 glucose = 2 ATP

Krebs cycle and stuff

Question 7

Daily sources of lactate?

Answer 7

Skeletal muscle
Skin
Brain
Intestine
RBC

Reference range <2mmol/L

Question 8

Lactate sources when sick or injured?

Answer 8

Lungs - 2/2 inflammation

Leukocytes - phagocytosis

Question 9

When sick or injured the disease?

Answer 9

Disease process blocks ETC

- body switches to alcoholic fermentation (anaerobic)

Question 10

How is lactate cleared?

Answer 10

60% liver
30% kidney
10% heart/skeletal muscle

Question 11

What is the Cori cycle?

Answer 11

The way the liver clears lactate

Question 12

What type of lactic acidosis is shock?

Answer 12

Shock - type A lactic acidosis

Question 13

If you suspect shock but pt is VSS?

Answer 13

They can still be in shock

Question 14

Lactate is the devil right?

Answer 14

Nope, its not itself harmful 
But increased lactate represents
- poor tissue delivery
- poor cellular function
- poor clearance
- symptom of more serious problem

Question 15

What does the surviving sepsis guidelines say about lactate?

Answer 15

Trzecik et al
- <2.2-4 ok, >4 = badness

Shipiro et al

• <2 = 4% survival
• 2-4 = 9% survival
• > 4 = 28% survival

BLUF
>4mmol/L needs aggressive resuscitation

Question 16

Choice of fluid for resuscitation?

Answer 16

LR
- NS if you have to

Dont use the other shit

Question 17

LR stats?

Answer 17

pH 6.6
Na 130
K 4
Ca 3
Cl 109
Lactate 28

Question 18

NS stats?

Answer 18

PH 5.0
Na 154
K 0
Ca 0 
Cl 154

Question 19

Why do trauma pts need LR?

Answer 19

Chloride metabolic acidosis
- esp burn pts

MCC cause of acidosis in burn pts was 2/2 aggressive resuscitation w NS

Question 20

What is acidosis?

Answer 20

Inability for glucose to undergo kreb cycle -> lactate formation

• biomarker for shock

Question 21

Drugs/toxins that cuase B2 acidosis?

Answer 21

Tylenol
EtOH
Epinephrine
Coke/meth
INH
Lanazolid
TPN
Thiamine/bioten deficiency
Metformin/fenformin

Question 22

Propofol and lactate?

Answer 22

Propofol infusion syndrome

• rare/life threatening
• metabolic acidosis
• rhabdo
• arrhythmias

Maj present w lactate >4mmol/L >48h but can happen sooner

Question 23

He said no subtypes of acidosis but

Answer 23

18-21 and 26-30

If you have trust issues

Question 24

I’m not addicted to brake fluid

Answer 24

I can stop whenever i want