Key messages

• Lactate production is increased when oxygen availability in the tissues is reduced, but increased cellular metabolism or altered pyruvate metabolism can also be implicated.

• The measurement of blood lactate levels can serve as an indicator of the presence of impaired tissue oxygenation, once other possible causes have been ruled out.

• A normal lactate level can be considered to be about 1 mmol/l, and levels above 1.5 to 2 mmol/l should alert the clinician to the possibility of tissue hypoxia.

• Lactate elimination occurs primarily in the liver.

• Blood lactate levels may reflect generalized poor tissue oxygenation but give no information on regional hypoxia.

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