Some of the important differences in detail of the studies are highlighted in Table I, which reveals, for example, that the type of venous blood used to compare with arterial blood differs. (One study includes a small cohort of healthy controls.) Lactate concentration of venous blood is compared with lactate concentration of arterial blood collected from the same patient at the same time, among a defined cohort of intensive care or emergency room patients. ![]() In essence, all these studies have a common and simple design based on the assumption that arterial blood is the gold standard sample. More than half of these studies are recently published (in the past 5 years), signifying that the issue remains relevant and to some extent, unresolved. The blood gas analyzers used for these assessments now commonly have the capacity for simultaneous measurement of lactate in the same arterial sample.Ĭomparing arterial and venous lactate concentration – study designĪ number of studies that test the validity of using venous blood in lieu of arterial blood for lactate measurement have been conducted since the first was published in 1987. It is considered the ”gold standard” sample for assessment of lactate measurement because it is derived from mixed venous blood and thus provides a representative sum of all sources of tissue lactate production.īy contrast, the concentration of lactate in venous blood could, theoretically at least, vary depending on the site of sampling because of variation, both physiological and pathological, in local tissue lactate production.Įarly studies that established the link between reduced blood perfusion and increased lactate – and thereby the clinical utility of lactate measurement – were conducted on arterial blood and lactate reference range was first established using arterial blood.Īrterial blood remains the gold standard sample for assessment of patient acid-base and oxygenation status. The article begins with a general discussion of the distinction between arterial blood and three types of venous blood that could be used for lactate measurement: peripheral venous blood, central venous blood and mixed venous blood.īlood sampling from different sites – some general considerationsĪrterial blood is constant in its lactate concentration irrespective of the site of sampling. ![]() ![]() Until fairly recently the evidence base was sparse and somewhat conflicting, but eight relevant studies have been published since 2011, and these will be a focus of this article. ![]() T he purpose of this article is to review the evidence base for the notion that venous blood lactate concentration approximates to that in arterial blood, and thereby, that venous blood is an acceptable alternative sample. In well-oxygenated tissues this lactate is metabolized further, but if tissues are inadequately oxygenated, lactate accumulates locally and blood concentration increases.Īs a blood marker of tissue hypoxia, lactate measurement has long-established clinical utility, most notably in the assessment and monitoring of acutely/critically ill patients and major trauma victims in emergency room and intensive care units.Īrterial blood is the gold standard sample for lactate measurement, but a reading of the literature and current practice suggests that venous blood is considered an acceptable alternative. Lactate is the end product of the metabolic process of glucose utilization, known as anaerobic glycolysis, which occurs in the cytoplasm of all cells.
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