Biochemistry of lactate production

Pyruvate is the end product of glycolysis. Most is then metabolised by pyruvate dehydrogenase to acetyl CoA, the major substrate for the Krebs cycle. However, in conditions of mitochondrial dysfunction (e.g. cellular hypoxia, sepsis) more pyruvate is converted to lactate by lactate dehydrogenase.

Lactate is a buffer not an acid so a high blood lactate is not, therefore, synonymous with lactic acidosis. In continuous haemofiltration the replacement fluid is usually buffered with lactate at 35-45mmol/l; thus blood lactate levels will rise without acidosis.

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