State of the Art Review
Journal of Veterinary Emergency and Critical Care 28(2) 2018, pp 106–121
Clinical use of plasma lactate concentration.
Part 2: Prognostic and diagnostic utility and
the clinical management of hyperlactatemia
Patricia G. Rosenstein, DVM ; Brett S. Tennent-Brown, BVSc, DACVIM, DACVECC and
Dez Hughes, BVSc, DACVECC
Objective – To review the current literature pertaining to the use of lactate as a prognostic indicator and
therapeutic guide, the utility of measuring lactate concentrations in body ﬂuids other than blood or plasma,
and the clinical management of hyperlactatemia in dogs, cats, and horses.
Data Sources – Articles were retrieved without date restrictions primarily via PubMed, Scopus, and CAB
Abstracts as well as by manual selection.
Human and Veterinary Data Synthesis – Increased plasma lactate concentrations are associated with increased
morbidity and mortality. In populations with high mortality, hyperlactatemia is moderately predictive in iden-
tifying nonsurvivors. Importantly, eulactatemia predicts survival better than hyperlactatemia predicts death.
Consecutive lactate measurements and calculated relative measures appear to outperform single measurements.
The use of lactate as a therapeutic guide has shown promising results in people but is relatively uninvestigated
in veterinary species. Increased lactate concentrations in body ﬂuids other than blood should raise the index
of suspicion for septic or malignant processes. Management of hyperlactatemia should target the underlying
Conclusion – Lactate is a valuable triage and risk stratiﬁcation tool that can be used to separate patients into
higher and lower risk categories. The utility of lactate concentration as a therapeutic target and the measurement
of lactate in body ﬂuids shows promise but requires further research.
(J Vet Emerg Crit Care 2018; 28(2): 106–121) doi: 10.1111/vec.12706
cat, dog, effusion, horse, hyperlactatemia, lactate, lactic acidosis, mortality, prognosis
AUROC area under the receiver operating characteris-
APPLE acute patient physiologic and laboratory eval-
CI conﬁdence interval
ED emergency department
GDV gastric dilation and volvulus
ICU intensive care unit
[LAC] lactate concentration/s
From the Department of Veterinary Clinical Sciences, Faculty of Veterinary
and Agricultural Sciences, University of Melbourne, Werribee, Victoria,
The authors declare no conﬂict of interests.
Address correspondence and reprint requests to
Dr. Dez Hughes, Veterinary Teaching Hospital, University of Melbourne, 250
Princes Highway, Werribee, Victoria 3030, Australia.
Submitted June 23, 2017; Accepted November 01, 2017.
NPV negative predictive value
OR odds ratio
PPV positive predictive value
central venous oxygen saturation
SOFA sequential organ failure assessment
SIRS systemic inﬂammatory response syndrome
Increased lactate concentrations ([LAC]) are associated
with increased disease severity, morbidity, and mor-
tality in many ill and injured human and veterinary
the physiology, pathophysiology, and measurement of
lactate. This second part evaluates the clinical utility of
lactate as a prognostic indicator and therapeutic guide,
the value of measuring lactate concentrations in body
ﬂuids other than blood, and the clinical management of
Veterinary Emergency and Critical Care Society 2018