Point of Care : Educational Guides : Introduction to Lactate in Veterinary Practice

Lactate testing for veterinary applications

Introduction to Lactate in Veterinary Practice


Lactate has long been used in human clinical practice as a diagnostic and prognostic aid in critically ill patients [REF[AM1] ]. Lactate can be used as aid to sepsis diagnosis and to aid in monitoring post-surgical morbidity, post-cardiac event morbidity, post-transplant morbidity and in assessing patients recovering from pneumonia.

Increasingly, lactate testing is being used in the veterinary clinic for prognosis and diagnosis in a number of clinical presentations [REF[SP2] ] and can be used as a triage and risk stratification tool for separating patientinto higher and lower risk categories [REF[SP3] ]. Additionally, the availability of reliable handheld lactate analysers with validated results comparable to laboratory-based lactate testing methods [REF[AM4] ] means that rapid, cost effective and near-patient results are now easily accessible as a prognostic and diagnostic aid for the veterinarian. 

 

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 [AM1]Singer et al 2016 JAMA 315 801-810; Shankar-Hari et al 2016 JAMA 315, 775-787; Vincent et al 2016 Critical Care

 [SP2]Sharkey & Wellman 2015 – Use of lactate in small anima clinical practice

 [SP3]https://www.ncbi.nlm.nih.gov/pubmed/29533517

J Vet Emerg Crit Care (San Antonio). 2018 Mar;28(2):106-121.

Clinical use of plasma lactate concentration. Part 2: Prognostic and diagnostic utility and the clinical management of hyperlactatemia.

Rosenstein PG1, Tennent-Brown BS1, Hughes D1.

 

 [AM4]Di Mauro & Schoeffler 2016; Acinero et al 2007; Karagiannis et al 2013

Vet-lactate-testing-in-small-animals
Lactate  is useful tool in treatment decision making

Rapid, cost effective, near patient results 

How are blood lactate measurements useful?

Whilst lactate is not diagnostic of any particular disease state when taken in isolation as a single reading, it is a useful triage tool in the overall treatment decision making pathway. It can be used as a guide to morbidity and/or the need to further investigate and monitor more closely specific patients. However, it should also be noted that trends in lactate levels provide better prognostic information than a single measure [REF[SP1] ].

Lactate is a normal by-product of energy use in the body produced largely during anaerobic metabolism[AM2] [GD3]  (see Figure 1) and typical levels are typically under  approximately [GD4] 2.0 mmol l-1. Elevated lactate levels (hyperlactatemia and lactic acidosis) are an indication of stress which will require further clinical investigation, as lactate is produced when cells are not getting sufficient oxygen to support normal aerobic energy production. This is usually due to tissue hypoperfusion and hypoxia when there is decreased blood flow to cells, either systemically or locally.

Measurements of blood lactate can, therefore, indicate the degree to which oxygen is being transported adequately around the body. As an increase in lactate levels occurs before changes in heart rate, blood pressure, or urine output, so this makes it a sensitive indicator of hypoperfusion [REF[SP5] ]. Thus offering ways of assessing the severity of pulmonary or cardiovascular disease, how the body responds to treatment, and the ability to predict health outcomes and influence decisions regarding the improvement of survival prospects [REFS[SP6] ].

Crucially, it should be noted that when considering treatment options for hyperlactatemia, the underlying cause of such elevated blood lactate concentration must first be established. Although poor perfusion is the most common reason, other factors can come into play. Such factors that can artificially raise lactate levels include: improper sample handling, excessive patient struggling and restraint and  prolonged venous occlusion when drawing a sample [REF[SP7] ].


 [SP1]M.Savigny & J.Berzon. Vetflio March 2019. Measuring Blood Lactate Levels

 [AM2]FIGURE - Do you have a diagram that could be used to illustrate this?

 [GD3]yes

 [GD4]are typically under

 [SP5]M.Savigny & J.Berzon. Vetflio March 2019. Measuring Blood Lactate Levels

 [SP6]Constable (1999) Blood Lactate and Pyruvate Concentrations in Cattle with Abomasal Volvulus. Dairy Cattle. Illinois Livestock Trailhttps://livestocktrail.illinois.edu/dairynet/paperDisplay.cfm?ContentID=303,

 

Sharkey (2013) Use of Lactate in Small Animal Clinical Practice. Veterinary Clinics of North America Small Animal Practice  43: 1287−97 https://www.researchgate.net/publication/258062768_Use_of_Lactate_in_Small_Animal_Clinical_Practice

 

 [SP7]M.Savigny & J.Berzon. Vetflio March 2019. Measuring Blood Lactate Levels

Use-of-Lactate-Testing-Equines
Blood lactate levels provide an indicator of muscle exertion

Note

EKF Diagnostics does not warrant the validity of the reported results and it is the responsibility of the individual veterinarian to balance the risk/benefits of any treatment pathway based on an understanding of the scientific data available.