Should Lactate be Considered a Critical Value?
Lactate is a surrogate biomarker for diagnosis of sepsis. Many laboratories have been asked to establish a critical value threshold for lactate. This action results in the calling and documenting of hundreds to thousands of additional critical values in a large hospital. Adding lactate to the critical value list might be beneficial if it resulted in faster detection and treatment of sepsis. But does it?
When lactate is ordered, it is almost always in the setting of critical care where clinicians are closely watching lab results and other data. Most abnormal lactates are seen in patients without sepsis. Elevated lactate values are seen in patients with cardiovascular disease, renal failure, trauma, liver disease, pulmonary disease, alcoholism, malnutrition and secondary to some medications such as beta agonists.The laboratory has no way to determine if an elevated lactate is associated with a patient being evaluated for sepsis.
Mayo Clinic published an article that concluded adding lactate to critical value reporting is resource intensive and rarely facilitates the recognition of sepsis or severe sepsis (Clin Chem Lab Med 2012;50:1819-23). So think before you jump!
