How long is lactate elevated after administration of epinephrine (adrenaline)?

From the Guidelines

Lactate levels typically remain elevated for 1-2 hours after adrenaline (epinephrine) administration. When adrenaline is given, either therapeutically or released endogenously during stress, it stimulates beta-adrenergic receptors, which increases glycolysis and produces lactate as a byproduct. This process, known as aerobic glycolysis or the Warburg effect, occurs even in the presence of adequate oxygen. The elevation in lactate is dose-dependent, with higher doses of adrenaline causing more significant and potentially longer-lasting lactate elevations. In clinical settings, this transient lactate elevation should be considered when interpreting blood gas results or assessing tissue perfusion in patients who have recently received epinephrine. For patients in shock or cardiac arrest who receive epinephrine as part of resuscitation, lactate levels may remain elevated longer due to the combination of drug effect and underlying tissue hypoperfusion.

Key Points

• Lactate elevation after adrenaline administration is a common phenomenon 1
• The duration of lactate elevation can vary depending on the dose of adrenaline and the patient's underlying condition 1
• Healthcare providers should be aware of this phenomenon to avoid misinterpreting lactate levels as indicating worsening shock when they may simply reflect recent adrenaline administration 1
• The Surviving Sepsis Campaign guidelines recommend guiding resuscitation to normalize lactate in patients with elevated lactate levels as a marker of tissue hypoperfusion 1
• However, the guidelines also note that lactate is not a direct measure of tissue perfusion and that increases in lactate levels may represent tissue hypoxia, accelerated aerobic glycolysis, or other causes 1

From the FDA Drug Label

Epinephrine increases glycogenolysis, reduces glucose up take by tissues, and inhibits insulin release in the pancreas, resulting in hyperglycemia and increased blood lactic acid [see Warnings and Precautions 5-(5.3)]. The duration of elevated lactate after being given adrenaline is not explicitly stated in the provided drug label.

• The label mentions that epinephrine increases blood lactic acid, but it does not provide information on how long this effect lasts. 2

From the Research

Lactate Elevation After Adrenaline Administration

• The duration of lactate elevation after adrenaline administration is not directly stated in the provided studies.
• However, a study published in 2011 3 measured blood lactate levels in patients with septic shock over a 24-hour period after adrenaline therapy was initiated, and found that lactate levels increased from 2.3 to 2.9 mmol x l(-1) during this time.
• Another study from 2013 4 discussed the various etiologies of elevated lactate levels, but did not provide specific information on the duration of lactate elevation after adrenaline administration.
• A 2021 study 5 found that patients with septic shock who received higher doses of norepinephrine (a vasopressor) had lower lactate clearance rates after resuscitation, but did not directly address the duration of lactate elevation after adrenaline administration.
• A 2020 review 6 discussed the complex metabolism and clearance of lactate, particularly in sepsis, and highlighted the importance of considering lactate levels in conjunction with other markers of tissue hypoperfusion to guide resuscitation.
• A 2013 study 7 measured lactate levels in patients with septic shock during resuscitation and found that lactate levels gradually declined over time, with a clearance rate of 15.4% from the initial measurement to 2 hours later.