Point-of-care lactate testing in emergency room
Abstract
Lactate is a product of anaerobic metabolism, which can be used to detect the critically ill. Rapid recognition, early appropriate treatment and control of treatment success are paramount in that population. Lactate levels need to be available as soon as possible if they are to be of assistance at the bedside. Point-of-care analyzers enable rapid determination of lactate. The role of point-of-care lactate analyzers in the treatment of the critically ill, different analysis techniques and limitations of point-of-care lactate analyzers are presented. The use of point-of-care lactate analyzers is demonstrated in two cases of patients with sepsis. The first patient is a 73-year-old female, where point-of-care lactate was determined immediately. Septic shock with multi-organ failure developed. She was successfully treated and discharged after 14 days to home care. The second patient is a 62-year old male, where elevated lactate was detected after three hours. The patient died after a total of 5 months of treatment in the intensive care unit. Lactate can be an important tool in early recognition and treatment of the critically ill.
Downloads
References
Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc. 2013; 88: 1127–40.
Khosravani H, Shahpori R, Stelfox HT, Kirkpatrick AW, Laupland KB. Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. Crit Care. 2009; 13: R90.
Krishna U, Joshi SP, Modh M. An evaluation of serial blood lactate measurement as an early predictor of shock and its outcome in patients of trauma or sepsis. Indian J Crit Care Med. 2009; 13: 66–73.
Hermans MA, Leffers P, Jansen LM, Keulemans YC, Stassen PM. The value of the Mortality in Emergency Department Sepsis (MEDS) score, C reactive protein and lactate in predicting 28-day mortality of sepsis in a Dutch emergency department. Emerg Med J. 2012; 29: 295–300.
Soremekun OA, Datner EM, Banh S, Becker LB, Pines JM. Utility of point-of-care testing in ED triage. Am J Emerg Med. 2013; 31: 291–6.
Shapiro NI, Fisher C, Donnino M, Cataldo L, Tang A, Trzeciak S et al. The feasibility and accuracy of point-of-care lactate measurement in emergency department patients with suspected infection. J Emerg Med. 2010; 39: 89–94.
Gallagher EJ, Rodriguez K, Touger M. Agreement between peripheral venous and arterial lactate levels. Ann Emerg Med. 1997; 29: 479–83.
Goyal M, Pines JM, Drumheller BC, Gaieski DF. Point-of-care testing at triage decreases time to lactate level in septic patients. J Emerg Med. 2010; 38: 578–81.
Abbot point-of-care: Cartridge and Test Information Sheets. Dosegljivo na: http://www.abbottpointofcare.com/Customer-Info-Center/Cartridge-and-Test-Info-Sheets.aspx
Leino A, Kurvinen K. Interchangeability of blood gas, electrolyte and metabolite results measured with point-of-care, blood gas and core laboratory analyzers. Clin Chem Lab Med. 2011; 49: 1187–91.
Verelst S, Vermeersch P, Desmet K. Ethylene glycol poisoning presenting with a falsely elevated lactate level. Clin Toxicol (Phila). 2009; 47: 236–8.
Mizock BA, Falk JL. Lactic acidosis in critical illness. Crit Care Med. 1992; 20: 80–93.
Perrone J, Phillips C, Gaieski D. Occult metformin toxicity in three patients with profound lactic acidosis. J Emerg Med. 2011; 40: 271–5.
Rodrigo GJ, Rodrigo C. Elevated plasma lactate level associated with high dose inhaled albuterol therapy in acute severe asthma. Emerg Med J. 2005; 22: 404–8.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013; 39: 165–228.
Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA. Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy: A Randomized Clinical Trial. JAMA. 2010; 303: 739–46.
Jansen TC, van Bommel J, Mulder PG, Rommes JH, Schieveld SJ, Bakker J. The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study. Crit Care. 2008; 12: R160.
Vanni S, Socci F, Pepe G, Nazerian P, Viviani G, Baioni M, et al. High plasma lactate levels are associated with increased risk of in-hospital mortality in patients with pulmonary embolism. Acad Emerg Med. 2011; 18: 830–5.
Vanni S, Viviani G, Baioni M, Pepe G, Nazerian P, Socci F et al. Prognostic value of plasma lactate levels among patients with acute pulmonary embolism: the thrombo-embolism lactate outcome study. Ann Emerg Med. 2013; 61: 330–8.
Desmoulin F, Galinier M, Trouillet C, Berry M, Delmas C, Turkieh A, et al. Metabonomics analysis of plasma reveals the lactate to cholesterol ratio as an independent prognostic factor of short-term mortality in acute heart failure. PLoS One. 2013; 8: e60737.
Wada T, Hagiwara A, Yahagi N, Kimura A. Lactate clearance is a predictor of sustained bleeding in emergency room patients with moderate upper gastrointestinal bleeding. Crit Care. 2013; 17(Suppl 2): P239.
Kramar I, Nadu B, Galvani V, Soldatović G, Terčič D. Določanje vrednosti hemoglobina z metodo POCT. Zdrav Vestn. 2013; 81: 251–6.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
