Can ischemic bowel disease occur with normal lactate levels?

From the Guidelines

Ischemic Bowel Disease with Normal Lactate Levels

Ischemic bowel disease can occur with normal lactate levels.

Key Points

• Laboratory parameters, including lactate levels, are not sufficiently accurate to conclusively identify the presence or absence of ischemic or necrotic bowel 1.
• Elevated l-lactate, leukocytosis, and D-dimer may assist in diagnosis, but are not definitive 1.
• More than 90% of patients with ischemic bowel disease will have an abnormally elevated leukocyte count, and 88% will have metabolic acidosis with elevated lactate levels 1.
• However, patients may present with lactic acidosis due to dehydration and decreased oral intake, making differentiation of early ischemia versus irreversible bowel injury based on lactate level alone unreliable 1.
• Elevated serum lactate levels > 2 mmol/l are associated with irreversible intestinal ischemia, but normal lactate levels do not rule out ischemic bowel disease 1.
• Other biomarkers, such as D-dimer, intestinal fatty acid-binding protein (I-FABP), and serum alpha-glutathione S-transferase (alpha-GST), may assist in diagnosis, but further research is required to specify their accuracy and values 1.
• Computed tomography angiography (CTA) should be performed as soon as possible for any patient with suspicion of ischemic bowel disease, as delay in diagnosis is a dominant factor in high mortality rates 1.

From the Research

Ischemic Bowel Disease and Lactate Levels

• Ischemic bowel disease can occur with normal lactate levels, as lactate is not a specific marker for bowel ischemia 2, 3, 4
• Elevated lactate levels can indicate tissue hypoperfusion, but may not be specific to bowel ischemia 2, 4
• Studies have shown that lactate levels can be normal in patients with ischemic bowel disease, particularly in the early stages of the disease 3, 4

Diagnostic Value of Lactate

• Serum lactate has a moderate sensitivity for bowel ischemia, but its specificity is lower 2
• The predictive value of lactate for irreversible bowel ischemia is higher than for reversible ischemia 2, 5
• Lactate levels can be influenced by various factors, such as fluid resuscitation, and may not always reflect the extent of bowel ischemia 3, 5

Alternative Biomarkers

• Other biomarkers, such as D(-)-lactate and intestinal fatty acid-binding protein, have been investigated as potential markers for bowel ischemia 6, 4
• These biomarkers may have higher specificity for bowel ischemia, but larger studies are needed to confirm their clinical utility 6, 4