From the Guidelines
Hyperlactatemia presents with both specific and non-specific symptoms that vary based on severity, including unexplained fatigue, muscle weakness, abdominal discomfort, and shortness of breath during normal activities, and can progress to rapid breathing, increased heart rate, and decreased blood pressure in severe cases. The symptoms of hyperlactatemia can be divided into several categories, including:
- Early signs: unexplained fatigue, muscle weakness, abdominal discomfort, and shortness of breath during normal activities
- Moderate signs: nausea, vomiting, and altered mental status
- Severe signs: rapid breathing (tachypnea), increased heart rate (tachycardia), and decreased blood pressure The condition often occurs alongside metabolic acidosis, which can cause Kussmaul breathing (deep, rapid breathing) 1. Patients with hyperlactatemia may appear pale or have cool, clammy skin. The underlying cause of elevated lactate levels significantly influences symptom presentation - sepsis-related hyperlactatemia often includes fever and signs of infection, while hyperlactatemia from seizures may present with post-ictal symptoms. It's essential to note that early hyperlactatemia can be asymptomatic and only detected through laboratory testing, which is why lactate measurement is crucial in critically ill patients or those with suspected tissue hypoperfusion 1. Prompt recognition is vital as untreated severe hyperlactatemia can progress to lactic acidosis and potentially life-threatening organ dysfunction. The clinical manifestations of hyperlactatemia without acidosis (normal arterial pH) are variable and nonspecific, and patients starting NRTI treatment should be made aware of the symptoms of lactic acidemia and asked to report them promptly to their health care provider 1.
From the Research
Signs and Symptoms of Hyperlactatemia
The signs and symptoms of hyperlactatemia, also known as elevated lactate levels, can vary depending on the underlying cause. Some common causes of hyperlactatemia include:
- Tissue hypoperfusion, which can lead to shock, sepsis, and organ failure 2
- Sepsis, which can cause a range of symptoms including fever, chills, and hypotension 3, 4
- Trauma, which can lead to tissue damage and impaired lactate clearance 2
- Diabetic ketoacidosis, which can cause symptoms such as hyperglycemia, ketosis, and metabolic acidosis 2
- Liver disease, which can impair lactate metabolism and lead to elevated lactate levels 5, 6
Clinical Presentation
The clinical presentation of hyperlactatemia can include:
- Elevated lactate levels, which can be measured using blood tests 2, 3, 4, 5, 6
- Symptoms of tissue hypoperfusion, such as hypotension, tachycardia, and decreased urine output 2, 3
- Signs of sepsis, such as fever, chills, and hypotension 3, 4
- Symptoms of metabolic acidosis, such as nausea, vomiting, and abdominal pain 2, 6
- Impaired mental status, which can range from mild confusion to coma 6
Prognostic Value
Elevated lactate levels have been shown to be a predictor of mortality in critically ill patients, particularly those with sepsis or septic shock 4, 6. The prognostic value of lactate levels can be influenced by factors such as the underlying cause of hyperlactatemia, the severity of illness, and the effectiveness of treatment 3, 5.