UMEM Educational Pearls

Lactate levels help to confirm septic arthritis but what about bacterial meningitis.  As reported in the daily electronic ACEP newsletter a small study of 45 patients showed that all patients with a confirmed diagnosis of bacterial meningitis had a CSF lactate level > 3.5 mmol/L.  Therefore, it might be true that viral meningitis will only have  CSF lactate levels < 3.5 mmol/L. 

With only 45 patients, this finding is clearly not ready for Prime Time but consider adding it to your next CSF study so more data can be collected on the utility of this test.

The story as seen in ACEP eNews on September 14th, 2012 is:

CSF Levels Of Lactate May Be A Marker Of Viral Versus Bacterial Meningitis.

MedPage Today (9/14, Gever) reports, "Cerebrospinal fluid (CSF) levels of lactate were a perfect marker of viral versus bacterial meningitis in a small study, a researcher reported" at the Interscience Conference on Antimicrobial Agents and Chemotherapy. Researchers found that, "among 45 adults in whom the etiology of meningitis was microbiologically confirmed, all those with CSF lactate levels above 3.5 mmol/L had the bacterial form, whereas every patient with lower levels had viral meningitis."