Can hyperlactatemia (elevated lactate levels) correct on its own?

From the Guidelines

Hyperlactatemia can sometimes correct on its own, but it is crucial to seek medical evaluation to determine the underlying cause and prevent potential complications, as suggested by the Surviving Sepsis Campaign guidelines 1. When hyperlactatemia is mild and caused by temporary conditions, the body can naturally clear excess lactate through the liver and kidneys once the underlying cause is addressed. For instance, hyperlactatemia caused by strenuous exercise typically resolves within 30-60 minutes of rest, as the body's metabolic processes return to normal. Similarly, temporary hypoxia, dehydration, or medication effects may resolve once these conditions improve. However, it is essential to note that persistent or severe hyperlactatemia often requires medical intervention, especially when caused by serious conditions like sepsis, liver failure, or diabetic ketoacidosis.

Key Considerations

• The Surviving Sepsis Campaign guidelines recommend guiding resuscitation to normalize lactate in patients with elevated lactate levels as a marker of tissue hypoperfusion 1.
• The guidelines suggest that serum lactate is not a direct measure of tissue perfusion, but increases in serum lactate levels are associated with worse outcomes 1.
• A significant reduction in mortality was seen in lactate-guided resuscitation compared to resuscitation without lactate monitoring, as demonstrated by five randomized controlled trials 1.
• The guidelines recommend an initial target mean arterial pressure of 65 mm Hg in patients with septic shock requiring vasopressors, which may help in reducing mortality and morbidity 1.

Clinical Implications

• It is crucial to seek medical evaluation if experiencing elevated lactate levels, as hyperlactatemia can indicate serious underlying health issues that may require prompt treatment.
• Treatment should focus on addressing the root cause of hyperlactatemia, rather than the condition itself.
• The use of dynamic over static variables to predict fluid responsiveness, as well as frequent reassessment of hemodynamic status, can help guide resuscitation efforts 1.

From the FDA Drug Label

If metformin-associated lactic acidosis is suspected, general supportive measures should be instituted promptly in a hospital setting, along with immediate discontinuation of metformin hydrochloride tablets Hemodialysis has often resulted in reversal of symptoms and recovery

The answer to whether hyperlactatemia can correct on its own is no, as the drug label recommends immediate discontinuation of metformin and institution of general supportive measures, as well as prompt hemodialysis in cases of suspected lactic acidosis, to correct the condition and remove accumulated metformin 2.

From the Research

Hyperlactatemia Correction

• Hyperlactatemia, or elevated lactate levels, can be caused by various factors, including sepsis, cardiogenic shock, and medication toxicity 3, 4, 5, 6, 7
• In some cases, hyperlactatemia can correct on its own, particularly in cases of late-onset hyperlactatemia in cardiac surgery patients, which is often benign and self-limiting 5
• However, severe hyperlactatemia (lactate level ≥ 10 mmol/L) is associated with high mortality rates and often requires medical intervention 4, 6
• The correction of hyperlactatemia depends on the underlying cause, and treatment should focus on addressing the underlying condition, such as sepsis or medication toxicity 3, 4, 6, 7
• Lactate clearance is an important predictor of mortality in critically ill patients, and a lactate clearance of < 32.8% after 12 hours is associated with high mortality rates 4

Factors Affecting Hyperlactatemia Correction

• The presence of diabetes mellitus (DM) can affect lactate levels, and patients with DM may have higher lactate levels than non-DM patients 3
• The etiology of hyperlactatemia, such as sepsis or cardiogenic shock, can impact the likelihood of correction and mortality rates 4, 6
• Medication toxicity, such as that caused by β2-agonists like epinephrine, can induce hyperlactatemia and requires discontinuation of the offending medication 5, 7