From the Guidelines
A lactate level of 10 mmol/L in a patient with alcohol use is concerning for severe metabolic derangement and requires immediate attention to prevent further morbidity and mortality. The patient's elevated lactate level may be attributed to various factors, including alcoholic lactic acidosis, tissue hypoperfusion, and impaired oxygen delivery [ 1 ]. Given the potential for alcohol to increase lactate levels, base deficit may be a better predictor of prognosis than lactate in this scenario [ 1 ]. However, the initial lactate level and its trend over time can still provide valuable information about the patient's response to therapy and overall prognosis [ 1 ]. Key management strategies include:
- Aggressive IV fluid resuscitation using normal saline
- Administration of thiamine to prevent Wernicke's encephalopathy
- Correction of hypoglycemia and electrolyte imbalances
- Consideration of sodium bicarbonate for severe acidosis
- Monitoring of serial lactate measurements to guide ongoing management It is essential to address the patient's alcohol withdrawal symptoms and provide nutritional support to prevent further complications [ 1 ]. The goal of treatment is to improve the patient's morbidity, mortality, and quality of life by addressing the underlying causes of the elevated lactate level and providing supportive care.
From the Research
Lactate Levels in Alcohol Intoxication
- A lactate level of 10 in a patient with alcohol intoxication can be caused by various factors, including tissue hypoperfusion, seizures, and hypoxia 2.
- However, significant elevations of blood lactate are uncommon in acute ethanol intoxication, and other etiologies for the elevated lactate level should be considered 3.
- Lactic acidosis is a common condition encountered by critical care providers, and elevated lactate and decreased lactate clearance are important for prognostication 4.
Potential Causes of Elevated Lactate
- Tissue hypoperfusion may be the most common cause of elevation, but many other etiologies or contributing factors exist, including medication-related causes 2.
- Alcoholic ketoacidosis (AKA) is defined by metabolic acidosis and ketosis in a patient with alcohol use, and requires targeted therapies 5.
- Other potential causes of lactic acidosis, including hypoxia, seizures, and hypoperfusion, should be considered in patients with ethanol intoxication who are found to have lactic acidosis 3.
Management of Elevated Lactate
- Treatment of lactic acidosis continues to be aimed at the underlying source 4.
- Management of AKA includes fluid resuscitation, glucose and vitamin supplementation, electrolyte repletion, and evaluation for other conditions 5.
- The clinical and prognostic importance of an elevated lactate level varies widely by disease state, and specific therapy may need to be tailored to the underlying cause of elevation 2.