Reviewed and approved by the AAEM Board of Directors (11/28/2018)
Current emergency department (ED) management of sepsis includes serial measurements of serum lactate. Since the initial publication of the Surviving Sepsis Campaign Guidelines and the landmark study by Rivers and colleagues in 2001, numerous lactate measurement strategies have been introduced, including lactate clearance and lactate normalization. [1, 2] Although lactate elevation may be due to a number of etiologies including drugs, toxins and underlying disease processes, in sepsis and shock states it represents a metabolic byproduct of cellular ischemia or cytotoxicity. There is abundant literature with regards to the use of lactate as a marker of disease severity, endpoint of resuscitation, and predictor of mortality. Lactate measurement has been utilized in various ways including initial static measurement, changes in serial lactate measurements (lactate clearance) and normalization of lactate (generally defined as a final lactate of < 2.0-2.2 mmol/L).