UMEM Educational Pearls

Title: Pitfalls in Lactate Interpretation

Posted: 12/16/2025 by Mike Winters, MBA, MD (Updated: 12/17/2025)
Click here to contact Mike Winters, MBA, MD

Pitfalls in Lactate Interpretation

Lactate is one of the most common biomarkers used in critical care.
While an elevated lactate level is often attributed to impaired tissue oxygenation, an important pitfall in lactate interpretation in the critically ill is the failure to consider non-hypoxic causes of increased levels. These include:
- Enhanced glycolysis (B2-agonist administration, increased metabolic activity)
- Reduced clearance (hepatic failure, renal dysfunction, muscular dysfunction)
- Impaired tissue metabolism (mitochondrial dysfunction due to drug intoxication)
Additional pitfalls in lactate use in the critically ill include:
- Use of an isolated value rather than assessing longitudinal trends
- Failure to correlate elevated lactate levels with other markers of perfusion (i.e., capillary refill time)
- Use of rigid normalization targets rather than targeting therapeutic interventions to the full clinical picture

Levy B, et al. Lactate dynamics as a marker of perfusion: physiological interpretation and pitfalls. Intensive Care Med. 2025; 51:2145-8.