Accessibility

LabCorp and its Specialty Testing Group, a fully integrated portfolio of specialty and esoteric testing laboratories.

Patient Test Information

Lactate

  • Why Get Tested?

    To detect high levels of lactate in the blood, which may be an indication of lack of oxygen (hypoxia) or the presence of other conditions that cause excess production or insufficient clearing of lactate from the blood; this test is not meant to be used for screening for health status.

    When To Get Tested?

    When you have symptoms such as rapid breathing, nausea, and sweating that suggest a lack of oxygen or an abnormal blood pH (acid/base imbalance); when a healthcare practitioner suspects that you may be experiencing sepsis, shock, heart attack, severe congestive heart failure, kidney failure, or inadequately treated (uncontrolled) diabetes; when a healthcare practitioner suspects that you have inherited a rare metabolic or mitochondrial disorder; when you have symptoms of lactic acidosis such as sweet-smelling breath, belly pain, confusion or cool and clammy skin

    Sample Required?

    A blood sample is obtained by inserting a needle into a vein in the arm. Sometimes, an arterial sample is collected by inserting a needle into an artery. Occasionally, a sample of cerebrospinal fluid is collected from the spinal column during a procedure called a spinal tap.

    Blood lactate levels will usually be drawn either without the use of a tourniquet or with a tourniquet that is not released during the blood draw. Tourniquet use and release and clenching of the fist can increase lactate levels in the blood sample.

    Test Preparation Needed?

    In general, no test preparation is needed. In some cases, a healthcare practitioner may request that you don't exercise for several hours before the test or refrain from eating or drinking anything other than water for 8 to 10 hours prior to the test.

  • What is being tested?

    Lactate is one of the substances produced by cells as the body turns food into energy (cell metabolism), with the highest level of production occurring in the muscles. Depending on pH, it is sometimes present in the form of lactic acid. However, with the neutral pH maintained by the body, most of it will be present in the blood in the form of lactate. This test measures the amount of lactate in the blood or, less commonly, in the cerebrospinal fluid (CSF).

    Normally, the level of lactate in blood and CSF is low. Lactate is produced in excess by muscle cells, red blood cells, brain, and other tissues when there is insufficient oxygen at the cellular level or when the primary way of producing energy in the body's cells is disrupted. Excess lactate can lead to lactic acidosis.

    The principal means of producing energy within cells occurs in the mitochondria, tiny power stations inside most cells of the body. The mitochondria use glucose and oxygen to produce ATP (adenosine triphosphate), the body's primary source of energy. This is called aerobic energy production.

    Whenever cellular oxygen levels decrease and/or the mitochondria are not functioning properly, the body must turn to less efficient energy production to metabolize glucose and produce ATP. This is called anaerobic energy production and the primary byproduct is lactic acid, which is processed (metabolized) by the liver.

    Lactic acid can accumulate in the body and blood when it is produced faster than the liver can break it down.

    Excess lactate may indicate one or a combination of the following:

    • Lack of oxygen (hypoxia)
    • The presence of a condition that causes increased lactate production
    • The presence of a condition that causes decreased clearance of lactate from the body

    When lactic acid production increases significantly, the affected person is said to have hyperlactatemia, which can then progress to lactic acidosis as more lactic acid accumulates. The body can often compensate for the effects of hyperlactatemia, but lactic acidosis can be severe enough to disrupt a person's acid/base (pH) balance and cause symptoms such as muscular weakness, rapid breathing, nausea, vomiting, sweating, and even coma.

    There are a number of conditions that can cause high levels of lactate. See "What does the test result mean?" in Common Questions below for more information.

  • How is it used?

    The lactate blood test is primarily ordered to help determine if someone has lactic acidosis, a level of lactate that is high enough to disrupt a person's acid-base (pH) balance.

    • Lactic acidosis is most commonly caused by an inadequate amount of oxygen in cells and tissues (hypoxia). If someone has a condition that may lead to a decreased amount of oxygen delivered to cells and tissues, such as shock or congestive heart failure, this test can be used to help detect and evaluate the severity of hypoxia and lactic acidosis. It may be ordered along with blood gases to evaluate a person's acid/base balance and oxygenation.
    • As lactic acidosis may also be caused by conditions unrelated to oxygen levels, this test may be used to evaluate someone who has a disease that can lead to increased lactate levels and who has signs and symptoms of acidosis. It may be ordered along with groups of tests, such as the comprehensive metabolic panel (CMP), basic metabolic panel (BMP), or complete blood count (CBC), to determine if an underlying condition, such as liver or kidney disease, is causing lactic acidosis.
    • The lactate test may also be used as part of an initial evaluation of someone who is suspected of having sepsis. Typically, if the person's lactate level is above normal limits, treatment will be initiated without delay. If a person with sepsis can be diagnosed and treated promptly, their chances of recovery are significantly improved.
    • Lactate levels may be used to help monitor hypoxia and response to treatment in a person being treated for an acute condition, such as sepsis, shock or heart attack, or a chronic condition, such as severe congestive heart failure.

    A cerebrospinal fluid (CSF) lactate test may be ordered, along with a blood lactate test, to help distinguish between viral and bacterial meningitis.

    When is it ordered?

    A lactate test may be ordered when someone has signs and symptoms of inadequate oxygen (hypoxia) such as:

    • Shortness of breath
    • Rapid breathing
    • Paleness
    • Sweating
    • Nausea
    • Muscle weakness
    • Abdominal pain
    • Coma

    The test may be ordered when a person has signs and symptoms that a healthcare practitioner suspects are related to sepsis, shock, heart attack, severe congestive heart failure, kidney failure, or uncontrolled diabetes.

    The lactate test may be initially ordered with other tests to help evaluate a person's condition. If lactate is significantly elevated, it may be ordered at intervals to monitor the condition.

    CSF and blood lactate levels may be ordered when a person has signs and symptoms of meningitis, such as severe headaches, fever, delirium, and loss of consciousness.

    What does the test result mean?

    A high lactate level in the blood means that the disease or condition a person has is causing lactate to accumulate. In general, a greater increase in lactate means a greater severity of the condition. When associated with lack of oxygen, an increase in lactate can indicate that organs are not functioning properly.

    However, the presence of excess lactate is not diagnostic. A healthcare practitioner must consider a person's medical history, physical examination, and the results of other diagnostic tests in order to determine the cause and to diagnose the underlying condition or disease.

    A number of conditions can cause elevated lactate levels. They are separated into two groups according to the mechanism by which they cause lactic acidosis.

    Type A lactic acidosis, the most common type, may be due to conditions that cause a person to be unable to breathe in enough oxygen (inadequate oxygen uptake in the lungs) and/or cause reduced blood flow, resulting in decreased transport of oxygen to the tissues (decreased tissue perfusion). Examples of type A conditions include:

    • Shock from trauma or extreme blood loss (hypovolemia)
    • Sepsis
    • Heart attack
    • Congestive heart failure
    • Severe lung disease or respiratory failure
    • Fluid accumulation in the lungs (pulmonary edema)
    • Very low level of red blood cells and/or low hemoglobin (severe anemia)

    Type B lactic acidosis is not related to delivery of oxygen but reflects excess demand for oxygen or metabolic problems. Examples of type B causes include:

    • Liver disease
    • Kidney disease
    • Inadequately treated (uncontrolled) diabetes
    • Leukemia
    • AIDS
    • Rare glycogen storage diseases (such as glucose-6-phosphatase deficiency)
    • Use of certain drugs such as aspirin (salicylates) and metformin
    • Exposure to toxins such as cyanide and methanol
    • A variety of rare inherited metabolic and mitochondrial diseases that are forms of muscular dystrophy and affect normal ATP production (see the Related Content below for links to more information on these)
    • Strenuous exercise, as with marathon runners

    When someone is being treated for lactic acidosis or hypoxia, decreasing concentrations of lactate over time reflect a response to treatment.

    When someone has signs and symptoms of meningitis, significantly increased cerebrospinal fluid lactate levels suggest bacterial meningitis while normal or slightly elevated levels are more likely to be due to viral meningitis.

    The lactate test measures the level of lactate in the blood at a given point in time. A normal lactate level indicates that a person does not have lactic acidosis, that there is sufficient oxygen at the cellular level, and/or that their signs and symptoms are not caused by lactic acidosis.

    Is there anything else I should know?

    Increased lactate levels may be seen with thiamine (vitamin B1) deficiency. Certain medications, including metformin and HIV drugs, can cause high lactate levels.

    Is there anything I can do to decrease my lactate level?

    Generally, no. However, if your elevated lactate level is due to an underlying condition that can be addressed, such as uncontrolled diabetes or a substance that can be avoided, such as ethanol, then you may be able to lower it. If you have been diagnosed with a condition, such as a metabolic disorder, following your prescribed treatment regimen should control your lactate level. If the increase is due to a temporary condition, such as shock or infection, then it will usually return to normal after the condition has been resolved.

    Why would a healthcare practitioner choose to measure lactate in a blood sample from an artery rather than blood from a vein?

    Lactate measurements from arterial blood are thought to be more accurate and, because a tourniquet is not used, they are not generally affected by the collection process. A healthcare practitioner may order an arterial lactate for these reasons or because a sample for a group of other tests called arterial blood gases (ABGs) is being collected at the same time and the same sample can be used for all tests. When other arterial blood tests are not being ordered, a healthcare practitioner may order a venous lactate because it provides an adequate evaluation of a person's lactate level and because the collection process is not as uncomfortable.

    Are there other ways to measure lactate than by sending a blood sample to the lab for testing?

    Yes. Lactate may be measured using a small hand-held device much like a glucose meter at the point of care (POC, at a patient's bedside) instead of in a laboratory. This type of monitoring is useful, for example, in emergency departments and intensive care units where rapid results are vital to the care of critically ill people. However, since the methods of measurement are different, the results from lactate POC tests may not be comparable with those from tests performed in a laboratory.

    What is the lactate/pyruvate ratio and how is it used?

    A lactate/pyruvate ratio is a calculated result that may be used to differentiate between causes of lactic acidosis.

    Pyruvate is a substance produced by and used by cells in the production of energy. The mitochondria within cells metabolize glucose in a series of steps to produce ATP, the body's energy source. One of the steps involves pyruvate and the following step requires oxygen. When the oxygen level is low, pyruvate accumulates and is converted to lactate, resulting in an accumulation of lactate and lactic acidosis. An alternative cause is when there is impaired mitochondrial function and the pathway is interrupted, resulting in increased pyruvate and hence more lactate. The lactate/pyruvate ratio will be high in these cases.

    However, there are certain congenital disorders (inborn errors of metabolism) in which pyruvate is not converted to lactate. One example is pyruvate dehydrogenase deficiency. In these cases, pyruvate will accumulate, the blood level will be high, and the lactate to pyruvate ratio will be low.

  • Health Professionals – LOINC

    LOINC Observation Identifiers Names and Codes (LOINC®) is the international standard for identifying health measurements, observations, and documents. It provides a common language to unambiguously identify things you can measure or observe that enables the exchange and aggregation of clinical results for care delivery, outcomes management, and research. Learn More.

    Listed in the table below are the LOINC with links to the LOINC detail pages. Please note when you click on the hyperlinked code, you are leaving Lab Tests Online and accessing Loinc.org.

    LOINC LOINC Display Name
    59032-3 Lactate (Bld) [Mass/Vol]
    30242-2 Lactate (BldA) [Mass/Vol]
    51829-0 Lactate (BldC) [Mass/Vol]
    30241-4 Lactate (BldV) [Mass/Vol]
    27941-4 Lactate (CSF) [Mass/Vol]
    14118-4 Lactate [Mass/Vol]
    32693-4 Lactate (Bld) [Moles/Vol]
    2518-9 Lactate (BldA) [Moles/Vol]
    19239-3 Lactate (BldC) [Moles/Vol]
    19240-1 Lactate (BldMV) [Moles/Vol]
    2519-7 Lactate (BldV) [Moles/Vol]
    2520-5 Lactate (CSF) [Moles/Vol]
    2524-7 Lactate [Moles/Vol]
  • View Sources

    Sources Used in Current Review

    (October 9, 2017) Lactic Acid. University of Michigan Medicine. Available online at https://www.uofmhealth.org/health-library/hw7871#hw7874. Accessed on 6/5/18.

    (April 4, 2013) Etiology and therapeutic approach to elevated lactate. Mayo Clinic Proceedings. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3975915. Accessed on 6/5/18.

    Lactate Information Sheet for Clinicians. Clinical Excellence Commission. Available online at http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0007/259387/lactate-information-sheet-for-clinicians.pdf. Accessed on 6/6/18.

    (April 27, 2018) Lactic Acidosis. Medscape. Available online at https://emedicine.medscape.com/article/167027-overview?pa=5Z9vIFRH5l1pOUB%2Fx4oi9qbCs%2B3z8Zw4bqpC0whkiaVEcNpoHbq5x79lDN%2FYNmXz8SIvl8zjYv73GUyW5rsbWA%3D%3D. Accessed on 6/6/18.

    Sources Used in Previous Reviews

    Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

    Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO. Pp. 527-528

    Datta, V. Updated (2005 May 17). Lactic acid. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003507.htm.

    Owens, T., Updated (2004 October 20). Lactic acidosis. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000391.htm.

    (2002 January, Updated). Lactate (Liquid) Reagent Set. Pointe Scientific, Inc. [On-line Reagent Package Insert]. Available online at http://pointescientific.com/products/inserts/PI-L7596.pdf#search='lactate%20reagent%20blood%20test.

    (© 2000). Simplified Reagent Handling LAC Lactate Ion. Beckman Coulter [On-line information]. Available online at http://www.beckman.com/literature/ClinDiag/GC9157GGLAC.pdf#search='Lactic%20acid%20reagent%20blood%20test.

    Hall, K. and Zalman, B. (2005 June 15). Evaluation and Management of Apparent Life-Threatening Events in Children. American Family Physician [On-line journal]. Available online at http://www.aafp.org/afp/20050615/2301.html.

    Parham, Sue (2005 March). In right setting, POC testing can be kid stuff. College of American Pathologists, CAP Today [On-line journal]. Available online at http://www.cap.org/apps/docs/cap_today/feature_stories/0305POC.html.

    (© 2005). Lactic Acid, Plasma. ARUP's User's Guide [On-line information]. Available online at http://www.aruplab.com/guides/ug/tests/0020045.jsp.

    (2001 October). Lactic Acid and Biopsy Tests. MDA Ask the Experts [On-line information]. Available online at http://www.mdausa.org/experts/question.cfm?id=2104&disease=97.

    Hesterlee, S. (1999 October). Mitochondrial Disease In Perspective Symptoms, Diagnosis And Hope For The Future. MDA QUEST v6(5) [On-line publication]. Available online at http://www.mdausa.org/publications/Quest/q65mito.html.

    (2001 November). Facts about Mitochondrial Myopathies. MDA Publications [On-line information]. Available online at http://www.mdausa.org/publications/mitochondrial_myopathies.html.

    Westerblad, H. and Allen, D. (2002 December 18). Recent Advances in the Understanding of Skeletal Muscle Fatigue. Medscape, from Current Opinion in Rheumatology [On-line information]. Available online at http://www.medscape.com/viewarticle/444388.

    Nissl, J. (2004 October 28). Lactic Acid. WebMD Health Guide A-Z [On-line information]. Available online at http://my.webmd.com/hw/lab_tests/hw7871.asp.

    Pagana, Kathleen D. & Pagana, Timothy J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp. 584-585.

    Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry, AACC Press, Washington, DC. Pp. 322.

    Wu, A. (2006). Tietz Clinical Guide to Laboratory Tests, Fourth Edition. Saunders Elsevier, St. Louis, Missouri. Pp. 650-653.

    Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition]. Pp. 1068.

    Karon, B. et. al. (2007 August 22). Comparison of Lactate Values Between Point-of-Care and Central Laboratory Analyzers. Medscape from Am J Clin Pathol. 2007;128(1):168-171 [On-line information]. Available online at http://www.medscape.com/viewarticle/559974. Accessed on 11/23/08.

    Van Voorhees, B. (2007 May 17, Updated). Lactic acid test. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003507.htm. Accessed on 11/27/08.

    Nicks, B. et. al. (2008 April 9, Updated). Lactic Acidosis. emedicine [On-line information]. Available online at http://www.emedicine.com/emerg/topic291.htm. Accessed on 11/27/08.

    (Updated March 27, 2007) Sharma S, Lactic Acidosis, eMedicine. Available online at http://emedicine.medscape.com/article/167027-overview. Accessed February 2009.

    Mizock B, Falk J. Lactic Acid in Critical Illness. Critical Care Medicine Vol. 20 No. 1 January, 1992.

    Lactic acid test. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003507.htm. Accessed March 2011.

    Glatter, R. and Winters, M. (2009 January 8). What Is the Clinical Utility of Obtaining Serum Lactate and Arterial Base Deficit Values in Patients With Early Signs of Sepsis and Septic Shock? Medscape Today. [On-line information]. Available online at http://www.medscape.com/viewarticle/585490. Accessed March 2011.

    Filbin, M. (Updated 2010 November 5). Septic Shock. eMedicine [On-line information]. Available online at http://emedicine.medscape.com/article/786058-overview. Accessed March 2011.

    Boggs, W. (2010 June 17). Targeting Lactate Clearance Improves ICU Outcomes Medscape Today from Reuters Health Information [On-line information]. Available online at http://www.medscape.com/viewarticle/723725. Accessed March 2011.

    Nicks, B. et. al. (2010 April 29). Lactic Acidosis in Emergency Medicine. eMedicine [On-line information]. Available online at http://emedicine.medscape.com/article/768159-overview. Accessed March 2011.

    (© 1995-2011). Unit Code 8657: Pyruvic Acid, Blood. MayoClinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8657. Accessed March 2011.

    (© 1995-2011). Unit Code 8665: Lactate, Plasma. MayoClinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/8665. Accessed March 2011.

    Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 601-602.

    Wu, A. (© 2006). Tietz Clinical Guide to Laboratory Tests, 4th Edition: Saunders Elsevier, St. Louis, MO. Pp 650-653.

    Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry, AACC Press, Washington, DC, Pg 232.

    Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson R, Pincus M, eds. Philadelphia, PA: Saunders Elsevier: 2007, Pp 163,197.

    Debray, FG. Diagnostic Accuracy of Blood Lactate-to-Pyruvate Molar Ratio in the Differential Diagnosis of Congenital Lactic Acidosis. Clin Chem, May 2007 53: 917-921.

    Surviving Sepsis Campaign Guidelines (2008). Available online at http://www.survivingsepsis.org/guidelines/Pages/default.aspx. Accessed June 2011.

    Rollins, Gena. The State of Sepsis Care. Clinical Laboratory News. March 2011: Volume 37, No 3. 

    (July 2010) Shaprio N, et al. The Feasibility and Accuracy of Point-of-Care Lactate Measurement in Emergency Department Patients with Suspected Infection. The Journal of Emergency Medicine. Volume 39, Issue 1, July 2010, Pp 89-94.

    Dugdale, D. (Updated 2013 May 5). Lactic acid test. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003507.htm. Accessed October 2014.

    Gunnerson, K. (Updated 2013 June 24). Lactic Acidosis. Medscape Drugs & Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/167027-overview. Accessed October 2014.

    (© 1995–2014). Lactate, Plasma. Mayo Clinic Mayo Medical Laboratory [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/8665. Accessed October 2014.

    Lewis, J. (Revised 2013 February). Metabolic Acidosis. The Merck Manual Professional Edition [On-line information]. Available online through http://www.merckmanuals.com. Accessed October 2014.

    Dietzen, D. (2012 August 3). Lactate and Lactic Acidemia. Clinical Chemistry Trainee Council Pearls of Laboratory Medicine [On-line information]. Available online through http://www.aacc.org. Accessed October 2014.

    Couturier, M. et. al. (Updated 2014 March). Metabolic Acidosis. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/MetabolicAcidosis.html?client_ID=LTD#tabs=0. Accessed October 2014.

    Gaieski, D. et. al. (2013). Accuracy of Handheld Point-of-Care Fingertip Lactate Measurement in the Emergency Department. Medscape Multispecialty from Western J Emerg Med v14 (1):58-62. [On-line information]. Available online at http://www.medscape.com/viewarticle/780165. Accessed October 2014.