The ten pitfalls of lactate clearance in sepsis

Lactate as a goal of what?

The complexity of lactate as a molecule, substrate, biomarker, energy source, component of some intravenous fuids, and major modulator of cellular bioenergetics during physiological stress is formidable

Such complexity makes it impossible to defne what goal it should be a marker or target of. Seeking to lower lactate levels (by whatever means given the multiple events that regulate its blood levels) has no credibility and no logic in terms of hemodynamics, bioenergetics, or tissue protection. In fact, it could make more biological sense to assist the natural process of lactate utilization and generation during sepsis or during other physiological stress situations by administering lactate. Until we are able to define the goals that we wish to achieve by manipulating lactate and have the means of measuring whether we have achieved such goals or not, the idea of seeking to lower lactate by increasing its “clearance” in sepsis is both an illusion and a folly.


Jan Bakker, Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, Netherlands