Unusually high serum lactate in patient presenting with septic shock

Badar Afzal, Emaduddin Siddiqui, Sayyeda Ghazala Kazi, Irum Qamar Khan, Muhammad Daniyal, Muhammad Abdul Raffay Khan


Septic shock has high mortality and can present atypically. Serum lactate, a useful biomarker for early recognition, has direct correlation with the mortality. It simply represents organ dysfunction and its relation with mortality has been widely studied. This case of a 65 year old man highlighting the extremely high lactate level with septic shock and its correlation with the clinical condition and outcome of the patient. He presented to the Emergency department (ED) with signs and symptoms of severe sepsis with initial serum lactate of 62.4 mmol/L measured in ED. Appropriate management was started including fluids and antibiotics, but his serum lactate remained elevated his condition deteriorated, eventually leading to death. High serum lactate levels can be a useful marker to timely identify and manage patients with severe sepsis, decreasing the mortality.


Serum lactate, Septic shock, Mortality

Full Text:



Ellrodt AG. Sepsis and septic shock. Emergency Med Clin North Am. 1986;4(4):809-40.

Berger T, Jeffrey G, Timothy H, Hagar Y, Garg N, Suarez A, et al. Shock Index and Early Recognition of Sepsis in the Emergency Department: Pilot Study. Western J Emergency Med. 2013;14(2):168-74.

Soto-Torres F, Ruiz-Rodríguez DL. Initial management of sepsis in the emergency room: "Time is life". (Article in Spanish) Bol Asoc Med P R. 2009;101(3):22-8.

Jones AE, Puskarich MA. Is lactate the "Holy Grail" of biomarkers for sepsis prognosis? Crit Care Med. 2009;37(5):1812-3.

Daniels R. Surviving the first hours in sepsis: getting the basics right (an intensivist’s perspective). J Antimicrob Chemother. 2011;66(Suppl2):11–23.

Liu G, Lv H, An Y, Wei X, Yi X, Yi H. Early actate levels for prediction of mortality in patients with sepsis or septic shock: a meta-analysis. Int J Clin Exp Med. 2017;10(1):37-47.

Walker CA, Griffith DM, Gray AJ, Datta D, Hay AW. Early lactate clearance in septic patients with elevated lactate levels admitted from the emergency department to intensive care: time to aim higher? J Crit Care. 2013;28(5):832-7.

Juel C. Muscle pH regulation: role of training. Acta Physiol Scand. 1998;162(3):359-66.

Juel C. Lactate-proton cotransport in skeletal muscle. Physiol Rev. 1997;77(2):321-58.

Bellomo R. Bench-to-bedside review: lactate and the kidney. Crit Care. 2002;6(4):322-6.

Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303–10.

Schulman AM, Claridge JA, Carr G, Diesen DL, Young JS, et al. Predictors of patients who will develop prolonged occult hypoperfusion following blunt trauma. J Trauma. 2004;57:795–800.

Trzeciak S, Dellinger RP, Chansky ME, Arnold RC, Schorr C, Milcarek B, et al. Serum lactate as a predictor of mortality in patients with infection. Intensive Care Med. 2007;33:970–7.

Howell MD, Donnino M, Clardy P, Talmor D, Shapiro NI. Occult hypoperfusion and mortality in patients with suspected infection. Intensive Care Med. 2007;33:1892–9.

Mikkelsen ME, Miltiades AN, Gaieski DF, Goyal M, Fuchs BD, Shah CV, et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med. 2009;37(5):1670-7.

Boschert S. Is It Septic Shock? Check Lactate Level. ACEP NewsNovember 2007. Elsevier Global Medical News. Available at: Clinical---Practice-Management/Is-It-Septic-Shock--Check-Lactate-Level/ Accessed on 08 August 2014.

Vitek V, Cowley RA. Blood lactate in the prognosis of various forms of shocks. Annals Surg. 1971;173(2):308-13.