The value of blood lactate measurements in ICU: an evaluation of the role in the management of patients on haemofiltration

In response to clinical demand some point-of-care analysers now provide blo od lactate measurements, but recently concern has been expressed about the value and interpretation of these measurements. We undertook this study to evaluate blood lactate measurements in patients with acute renal failure un dergoing haemofiltration (KF) with lactate replacement fluid. At baseline, 27 patients had base deficits of > 5 mmol/l and 14 (52%) had blood lactates of > 3.5 mmol/l. Lactate 'tolerance' was monitored by peak changes in thes e parameters during the procedure. There was a worsening of base deficit in only three of the patients in whom lactate rises exceeded 10 mmol/l with o ne survivor. Twelve patients with rises of blood lactate greater than 5 mmo l/l improved their base deficit (+1 to +17) with eight (67%) survivors. Of the remaining 12 patients with improved base deficit (+2 to +20), 10 (83%) survived. Lactate tolerance was compromised in patients with co-incidental liver disease, those on inotropic support, and in patients with initial blo od lactate measurements of > 10 mmol/l and large base deficits. The data su ggest that blood lactate and simultaneous acid-base response measurements d uring HF help to assign correct buffer replacement and should be performed on all patients. (C) 2001 Elsevier Science B.V. All rights reserved.