Manini et al correlated the serum lactate concentration of a patient with a drug overdose to mortality. The authors are from Mount Sinai School of Medicine, Saint Barnabas Hospital, New York Academy of Medicine and New York University.
Patient selection: drug overdose surviving to hospital discharge
Specimen: admission serum
The higher the serum lactate concentration the greater the risk for mortality.
An elevated serum lactate was associated with a metabolic acidosis.
Drugs with a high rate of hyperlactatemia in an overdose patient include ethanol, acetaminophen, opioids, antipsychotics, anticonvulsants and salicylates.
An overdose involve benzodiazepines was associated with a lower rate of hyperlactatemia compared to other drugs.
A serum lactate > 3.0 mmol/L was used to identify a high-risk population.
Differential diagnosis: elevated serum lactate due to sepsis or other cause
Performance:
• The area under the ROC curve was 0.87.
• The sensitivity was 84% sensitive and specificity 75%.
