From the Guidelines
Lactate levels in patients on adrenaline infusions can range from 2-4 mmol/L, but may increase to 5-7 mmol/L or higher depending on the dose and duration of therapy, as adrenaline stimulates glycolysis and increases lactate production even in well-oxygenated tissues 1.
Key Considerations
- The elevation in lactate levels is a normal physiological response to adrenaline, known as type B lactic acidosis, and not necessarily an indication of tissue hypoxia or shock.
- When monitoring patients on adrenaline infusions, it's crucial to interpret lactate levels in context with other clinical parameters such as blood pressure, heart rate, urine output, and peripheral perfusion.
- Lactate levels typically normalize within hours after reducing or discontinuing the adrenaline infusion.
Clinical Implications
- If lactate continues to rise significantly despite stable or improving hemodynamics, consider other causes of hyperlactatemia such as sepsis, tissue hypoperfusion, or liver dysfunction.
- The Surviving Sepsis Campaign guidelines suggest guiding resuscitation to normalize lactate in patients with elevated lactate levels as a marker of tissue hypoperfusion, although this is a weak recommendation with low quality of evidence 1.
- It's essential to reassess hemodynamic status frequently and use dynamic variables to predict fluid responsiveness, where available, to optimize patient management 1.
From the Research
Lactate Levels and Adrenaline Infusion
- The expected lactate level for someone on an adrenaline infusion is not explicitly stated in the provided studies, but it can be inferred that lactate levels may increase with adrenaline administration 2.
- A study found that peak lactate correlated with peak adrenaline (rho = 0.34, P = 0.032), suggesting a potential relationship between lactate levels and adrenaline infusion 2.
- However, another study suggests that a high lactate level following adrenaline administration may be a beneficial and appropriate response, rather than an adverse effect 2.
Vasopressor Management and Lactate Levels
- Norepinephrine is generally considered the first-line vasopressor in septic shock management, and its use has been associated with lower lactate levels compared to other vasopressors 3.
- The addition of vasopressin to norepinephrine may offer some clinical benefits, but its effect on lactate levels is not clearly established 4.
- Epinephrine, another vasopressor, is considered a second-line agent, but its impact on lactate levels is not well-defined in the provided studies 5, 3.
Clinical Implications
- Lactate levels are an important parameter in septic shock management, and their measurement can help guide fluid and vasopressor therapy 5, 4.
- The relationship between lactate levels and adrenaline infusion is complex, and further research is needed to fully understand its clinical implications 2.
- Individualized management strategies based on haemodynamic parameters, including lactate clearance and capillary refill time, are recommended for optimal patient outcomes 4.