The lactate level at any time is a balance between its production and its elimination. Overproduction of pyruvate, and hence of lactate, occurs primarily as the result of inadequate oxygenation as outlined above, although some can be produced from protein catabolism. Therefore excessive muscle breakdown, as seen in critical illness, could contribute to raised lactate levels. Since elimination occurs primarily in the liver, liver failure might be expected to cause abnormally high lactate levels. Patients with stable cirrhosis maintain relatively normal levels, but the presence of liver disease can certainly magnify levels already raised due to circulatory failure and slow down their return to normal once resuscitation is complete.
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