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Laktatspiegel: Entschlüsselung von Erhöhung und Laktazidose

Lactic acid (lactate) is a byproduct of anaerobic glycolysis. Blood levels reflect the balance between production and clearance (primarily by the liver, kidneys, and heart).

Normal Ranges

Arterial/Capillary whole blood: 0.5–2.2 mmol/L
Venous plasma/serum: 0.5–2.0 mmol/L
Adults typically <2.0 mmol/L; children run slightly higher.

Causes of Elevated Lactate

Type	Mechanism	Examples
Type A (Hypoxic)	Tissue hypoperfusion/hypoxia → anaerobic metabolism	Septic shock, cardiogenic shock, hemorrhage, severe anemia, cardiac arrest, sepsis, respiratory failure
Type B (Non-hypoxic)	Impaired clearance or increased production without hypoxia	Liver failure, renal failure, diabetes (metformin), malignancies, thiamine deficiency, toxins (cyanide, CO), seizures, alkalosis, drugs (NRTIs, propofol, beta-agonists)

Lactic Acidosis Presentation

Nausea, vomiting, abdominal pain, Kussmaul respirations.
Altered mental status, hypotension, tachycardia.
Severe cases: shock, multi-organ failure, coma.

Diagnosis & Management

Arterial/venous blood gas + lactate measurement.
Treat the underlying cause: fluids, vasopressors, antibiotics, source control, dialysis, thiamine, discontinuing offending drugs.
Sodium bicarbonate is controversial (consider if pH <7.1).

Serial lactate trends (clearance) guide resuscitation adequacy.

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