Table 1 Causes of perioperative hyperlactataemia and lactic acidosis in patients undergoing cardiac surgery Common Low cardiac output state Cardiogenic shock Distributive shock (sepsis, post-CPB shock state) Drug-related (adrenaline, salbutamol) Late-onset hyperlactataemia Uncommon Hepatic failure Severe hypoxia Severe anaemia Renal failure Severe hemolysis Large volume blood transfusion Excess lactate
metabolism (lactate-based renal- replacement therapy solutions) Malignant hyperthermia Drug-related (propofol, sodium nitroprusside) Pancreatitis Administration of Ringer's Lactate fluid CPB=cardiopulmonary bypass.
Measurement of blood or plasma lactate, specifically the measurement of lactate/pyruvate ratios and subsequently excess lactate
, became clinically important assays in the 1960s after these parameters were demonstrated to be of value in the evaluation and management of critically ill and injured patients.
14,18) It is postulated that being overweight, or weight gain, may predispose to hepatic steatosis, compromising the liver's ability to clear excess lactate
The virus replicates cytocidally in a subpopulation of permissive tissue macrophages that clears excess lactate
dehydrogenase from circulation.