The ten pitfalls of lactate clearance in sepsis

Hernandez, Glenn; Bellomo, Rinaldo; Bakker, Jan

The problem with clearance
Clearance is the removal of a substance from blood, expressed as a volume (milliliters) over time (minutes). However, changes in lactate levels are the sum of ongo- ing production and removal from the blood by excretion (e.g., urine, sweat) and its metabolism (e.g., uptake by cells as a direct source of energy, conversion to glucose by the liver). To talk about “lactate clearance” [1] when actually describing a decrease in blood level is wrong and misleading. Following the review of 96 studies, Vincent et al. [1] concluded that given recent evidence, measure- ments every 1–2 h would give clinically relevant data about the decrease in lactate levels.


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Intensive Care Medicine

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September 7, 2018