(Really) Quick Hit Article #7 – LR does not clinically increase serum lactate. If you believe in lactate…come along with me…

Source: J Emerg Med. 2018 Jul 20. pii: S0736-4679(18)30602-4

Today’s (really) quick hit is a neat little article trying to answer the question “Does Lactated Ringers increase your serum lactic acid.  Given that sepsis seems to be the only diagnosis of anymore, can our friend lactic acid still help us if we are giving 30 ml/kg of LR?

The Bottom Line:
In healthy (Non-ED) volunteers 30 ml/kg of LR modestly increased the serum lactate at 5 min after the infusion of fluid by about 1 mmol/L. This was statisticaly significant but probably not clinically relevant. Interestingly, the health patients baseline lactate was 1.05 in both groups. 

 The Graphic

 LR vs NS for lactate

The Details:

This is a simple but well done randomized double blinded controlled trial that was even prospectively registered at clinicaltrials.gov! They took healthy volunteers and gave each 30 ml/kg of NS and LR to 15 patients in each group. They measured the lactate in the contralateral arm and found the LR to increase from 1.06 to 1.99 and NS to increase the lactate form 1.05 to 1.42. The increase in lactate by LR was statistically significant compared to baseline. That being said it is still probably not a clinically significant difference but we cannot extrapolate this to septic ED patients. Besides they drew the lactate at 5 min after infusion. What happens at the 2 or 3-hour mark? Is it still increased? We will never know. Interestingly, the authors state, “…our study only had enough resources to check 1 repeat lactate and 1 repeat metabolic panel”. So in the end while this is interesting it’s probably not enough to make me worry that I have spuriously elevated my lactate by giving LR.

So keep giving LR or NS or whatever you fancy to resuscitate patients.


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