Minton and Sidebotham reviewed the types and causes of hyperlactatemia in a patient undergoing cardiac surgery. The authors are from the Alfred Hospital in Melbourne and Auckland City Hospital in New Zealand.
Patient selection: cardiac surgery
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Pathogenesis
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Designation
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impaired tissue oxygenation
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Type A
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tissue hypoxia absent
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Type B
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Hyperlactatemia may occur early or late.
(1) early onset occurs in the interval between start of cardiopulmonary bypass and arrival in the ICU
(2) late onset starts after admission to the ICU, typically within the first 6-12 hours
Type A causes:
(1) inadequate oxygen delivery during cardiopulmonary bypass
(2) low cardiac output
(3) severe anemia or hemodilution
(4) microcirculatory failure with impaired tissue perfusion
(5) hepatic ischemia
(6) limb ischemia
(7) mesenteric ischemia
(8) renal failure
(9) pancreatitis
(10) status post sodium nitroprusside therapy
Type B causes:
(1) accelerated glycolysis during SIRS, vasopressor therapy or seizure activity
(2) reduced lactate clearance by the liver
(3) administration of lactated Ringer's solution or lactate-buffered renal replacement fluid
(4) reduced lactate clearance due to renal failure
(5) propofol syndrome
