RELATIONSHIP BETWEEN BLOOD LACTATE CONCENTRATIONS AND IONIZED CALCIUM, GLUCOSE, AND ACID-BASE STATUS IN CRITICALLY ILL AND NONCRITICALLY ILL PATIENTS

Objective: To determine the relationships between circulating blood lactate concentrations and several biochemical variables including ionized calcium, glucose, pH, and acid-base status in critically ill and noncritically ill patients. Design: A prospective, cohort study. Setting: The critical care research laboratory, intensive care unit (ICU), emergency room (ER), and general ward of a 466 bed university-affiliated hospital. Patients: Three-hundred thirty-four critically ill and noncritically ill patients. Intervention: None. Measurements and Main Results: Circulating blood lactate concentrations, ionized calcium concentrations, blood glucose, pH, and base deficit values were simultaneously determined in blood samples from various patient populations. Descriptive data and physiologic parameters were also recorded. Circulating lactate and ionized calcium determinations were performed simultaneously in 334 whole blood samples from 334 subjects. There was neither a statistically significant nor clinically relevant correlation between circulating lactate concentrations and ionized calcium concentrations when lactate values were less than or equal to 2 mmol/L (p = 0.8962, r(2) = .01) or when lactate values were >2 mmol/L (p = .3697, r(2) = .09) in a heterogeneous patient population. Our study populations included five subject groups: a) nonhypotensive ICU patients (n = 93), b) nonhypotensive ER patients (n = 85), c) nonhypotensive general ward patients (n = 44), d) hypotensive patients from the ICU, ER, and general wards (n = 39), and e) normal controls (n = 73). There was neither a statistically significant nor clinically relevant correlation between circulating lactate concentrations and ionized calcium concentrations in each of the five populations studied for lactate values either less than or equal to 2 mmol/L or >2 mmol/L. We studied the relationship between circulating lactate concentrations and blood glucose concentrations (n = 334 patients), arterial pH and base deficit (n = 163 patients), and venous pH and base deficit (n = 171 patients). Statistically significant, but perhaps not clinically relevant correlations were observed when comparing circulating lactate values with blood glucose values (p =.0330, r(2) = .12), arterial pH (p = .0007, r(2) = .26) and base deficit from arterial specimens (p = .0014, r(2) = .25). There were neither statistically significant nor clinically relevant correlations when comparing circulating lactate concentrations with venous pH (p = .9098, r(2) = .01) or base deficit determined from venous blood specimens (p = .1365, r(2) = .11). Conclusions: a) There is neither a statistically significant nor clinically relevant relationship between whole blood lactate concentrations and ionized calcium concentrations when studying patients with or without hyperlactatemia. b) Although there is a statistically significant correlation between circulating lactate concentrations and blood glucose concentrations, arterial pH or arterial base deficit, such associations do not appear to be clinically important.