Lactate in sepsis and trauma--hindrance or help?

Physiologic hyperlactatemia must be distinguished from lactate acidosis (lactate > 5 mM/L, pH < 7.32). Sustained lactic acidosis, or changes in lactate in response to inotropic support, are useful predictors of mortality in severe sepsis and trauma, and superior to hemodynamic markers such as DO2 and VO2. Base deficit is a readily available surrogate for plasma lactate, and the addition of gastric tonometry enhances its predictive ability.