From the Guidelines
Lactemia and bleeding require immediate attention to control the bleeding source and restore tissue perfusion, with a focus on normalizing lactate levels as a marker of tissue hypoperfusion, as suggested by the Surviving Sepsis Campaign guidelines 1. When significant bleeding occurs, it can lead to tissue hypoperfusion and hypoxia, causing cells to shift to anaerobic metabolism, which produces lactic acid. This metabolic shift leads to lactic acidosis, a common finding in hemorrhagic shock.
Key Considerations
- Controlling the bleeding source through direct pressure, surgical intervention, or endoscopic techniques as appropriate is crucial.
- Hemodynamic support with intravenous fluids, such as crystalloids like normal saline or Ringer's lactate, at 30 mL/kg within the first 3 hours, as recommended by the Surviving Sepsis Campaign guidelines 1, is essential.
- Transfusing packed red blood cells for hemoglobin below 7-8 g/dL, and considering additional blood components like fresh frozen plasma and platelets for massive hemorrhage, may be necessary.
- Correcting any coagulopathy with appropriate factors and monitoring lactate levels every 2-4 hours to assess response to treatment is vital.
Treatment Goals
- Restore tissue perfusion and oxygen delivery to correct lactemia.
- Normalize lactate levels as a marker of tissue hypoperfusion, as suggested by the Surviving Sepsis Campaign guidelines 1.
- Persistent elevation of lactate despite bleeding control suggests ongoing tissue hypoperfusion or other causes of lactic acidosis that require further investigation.
From the Research
Lactemia and Bleeding
- Lactemia, or elevated lactate levels, can be caused by various factors, including tissue hypoperfusion, sepsis, and medication-related causes 2
- In critically ill patients, lactate levels are commonly evaluated to assess the severity of illness and guide fluid resuscitation strategies 3, 2
- The relationship between lactemia and bleeding is not directly addressed in the provided studies, but fluid resuscitation strategies using crystalloids or colloids may affect lactate levels and patient outcomes 4, 5, 6
- Crystalloids, such as normal saline, are commonly used for fluid resuscitation, but may not be as effective as colloids in stabilizing resuscitation endpoints 5
- The choice of fluid resuscitation strategy may depend on the underlying cause of lactemia and the patient's individual needs, but more research is needed to determine the optimal approach 4, 5, 6
Fluid Resuscitation Strategies
- Crystalloids, such as normal saline, are commonly used for fluid resuscitation, but may not be as effective as colloids in stabilizing resuscitation endpoints 5
- Colloids, such as albumin or hydroxyethyl starch, may be more effective than crystalloids in certain situations, but may also increase the risk of adverse events 4, 5
- Balanced crystalloids may be a better choice than normal saline for fluid resuscitation in critically ill patients, but more research is needed to determine the optimal approach 6
- The use of fluid resuscitation strategies may affect lactate levels and patient outcomes, but more research is needed to fully understand the relationship between lactemia and bleeding 3, 2, 4, 5, 6