UMEM Educational Pearls

Are Intermediate Lactate Levels Concerning in Patients with Suspected Infection?

  • It is well known that lactate levels > 4 mmol/L are associated with increased mortality in patients with suspected infection.
  • What is unclear, however, is the prognostic value of intermediate lactate levels (2.0-3.9 mmol/L) in patients with suspected infection.
  • Puskarich, et al. performed a systematic review to determine the risk associated with intermediate lactate levels.
    • 8 studies (> 11,000 patients) were included in the analysis
    • Mortality for patients with intermediate lactate levels but without hypotension was 15%
    • Mortality was > 30% for hypotensive patients with intermediate levels of lactate.
  • Take Home Point: Patients with intermediate lactate levels have an increased risk of mortality.
  • Though no current guidelines exist for the optimal care of these patients, aggressive care should continue until repeat levels demonstrate normalization.


Puskarich MA, et al. Prognosis of emergency department patients with suspected infection and intermediate lactate levels: A systematic review. J Crit Care 2014; 29:334-339