Usefulness of plasma lactate concentration in the diagnosis of acute abdominal disease.

OBJECTIVE

To verify the diagnostic importance of the plasma lactate concentration in acute abdominal disease and to examine its role as a marker of mesenteric ischaemia.

DESIGN

Prospective study.

SETTING

Two departments of surgery, one in Sweden and one in Germany.

SUBJECTS

85 patients with acute abdominal symptoms.

MAIN OUTCOME MEASURES

Correlation between the plasma lactate concentration before operation or (in the case of those not operated on) before the diagnosis was established, and the final diagnosis.

RESULTS

Plasma lactate concentrations exceeded the reference range in all cases of mesenteric ischaemia (n = 20) and general bacterial peritonitis (n = 15) and in half of the 20 cases of intestinal obstruction. They were also raised in 3 of 10 cases of acute pancreatitis.

CONCLUSIONS

A raised plasma lactate concentration is always a sign of an acute life-threatening condition, and usually indicates the need for an emergency operation. As a marker of mesenteric ischaemia its sensitivity was 100% and its specificity 42%. We conclude that a raised serum lactate concentration is the best marker of mesenteric ischaemia to date.