1. Pre-Hospital Lactate Pro
Point of Care Testing

2. Lactate Pro Meter
Lactate (Lactic acid)
• Level – venous: 0.5 - 2.2 mmol/L
• An increased lactate level is an indirect measure of tissue
hypoxia and a approximation of the magnitude, duration and
potential severity of shock.
• Trending of lactate levels
– Can describe the natural history of sepsis
– Guide therapy
– Predict outcome
• Lactate Metabolism ->
• Removal
– 60% Liver
– 30% Kidneys
– 10% Heart/Muscle

3. Lactate Pro Meter
Lactate (Lactic acid)
•
Inadequate oxygen delivery
–
–
–
–
•
Volume depletion or profound dehydration
Significant blood loss
Septic shock
Profound anemia
Disproportionate oxygen demands
– Severe hypoxemia
– Prolonged carbon monoxide exposure
– Trauma
•
Inadequate oxygen utilization
–
–
–
–
Hyperthermia
Shivering
Seizures
Strenuous exercise

4. Lactate Pro Meter
Hypoperfusion/Hypovolemia
• Elevated blood lactate levels despite normal vital signs
(occult hypoperfusion) are good markers of mortality in
post-operative surgical patients.
• Occult Hypoperfusion can present with baseline vitals
signs and a marginally elevated lactate( ≥ 2.4mmol/L)
• Elevated lactate could be indicative of prolonged period
of end organ hypoxia.
– End organ anaerobic metabolism

5. Lactate Pro Meter
Cyanide & CO Poisoning
• Cellular Hypoxia
• Cyanide changes the iron in hemoglobin from ferrous to
ferric oxide.
– Affecting oxygen binding properties
• CO has a 256x greater affinity for hemoglobin than does
Oxygen making it a competitive asphyxiate.

6. Lactate Pro Meter
Trauma
• The data therefore indicates that not only the initial or the
highest lactate value but also the duration of
hyperlactatemia can be correlated with the development
of organ failure. These observations stress the
importance of the initial resuscitation in the prevention of
organ failure. Serial blood lactate measurements are
reliable indicators of morbidity and mortality after trauma.
• Pre-hospital can be the initial value and initiate the
resuscitation interventions.
• Electrocution
• Compartment Syndrome (not just acute
trauma, prolonged elderly fall victim)

7. Lactate Pro Meter
Trauma
ITLS 7e pg 158

8. Lactate Pro Meter
Sepsis
• Suspected or significant history of possible infection
• Serum level (≥ 4mmol/L)
• Trending these from patient contact through discharge is
valuable.
– Fluid therapy is established to help shed lactate due to a
direct correlation to high serum lactate to low pH’s.

9. Lactate Pro Meter
Organ Transplant
• In patients whom are potential candidates need to meet
certain criteria.
• In terms of feasible lactate levels for organ donor
candidates depend on the program.
– The majority want levels to have remained below 16mmol/L
but some programs have raised their acceptable levels to
20mmol/L to increase candidate pools
• And most likely to mirror the trauma criteria

10. Lactate Pro Meter
Lactate Rises (other)
• Liver Failure- Lactic acidosis unrelated to tissue hypoxia has
been described in patients with liver disease.
• Renal Failure
• ASA/Tylenol Overdose
• Prolonged muscular work seen in construction workers, etc.
• Stimulant use (Cocaine, PCP, and all the other synthetics
out today)
• Tazer Victims
• Runners, especially those long distance. The day after can
sometimes be the worst for those under-conditioned.

11. Lactate Pro Meter

12. Lactate Pro Meter

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If lactate > 2 mmol:
-Infuse 30cc/kg 0.9% NaCl solution IV in all patient categories excluding trauma. Reassess patient and vital signs to necessitate further
fluid therapy.
-In trauma patients infuse 20cc/kg 0.9% NaCl solution IV in all patient categories excluding trauma. Reassess patient and vital signs to
necessitate further fluid therapy.
Repeat lactate determination after fluid infusion has completed and / or 20 minutes has elapsed after initiation of IV fluid therapy.
Refractory Hypotension: Consider Dopamine 10mcg/kg/min, with simultaneous 1000cc NaCl bolus.
Include lactate determination results when reporting to the receiving ED.
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