Lactate metabolism in Intensive Care Unit (ICU) patients with severe sepsis / septic shock with normal and elevated lactate values.

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Severe sepsis / septic shock are leading causes of death in ICU:s all around the world. Improvements have been made through early identification and standardization of resuscitation (through initiatives such as Surviving Sepsis Campaign and others). In the later versions of the resuscitation guidelines a bigger focus has been put on the measurements of plasma-lactate. Increased levels have been shown to correlate with worsened outcome but a normal lactate does not exclude critical condition. Even though it is used in clinical decision-making concerning potentially lifesaving treatment, the actual metabolism of lactate in sepsis is surprisingly poorly described. In this project we aim to describe the lactate metabolism (rate of appearance and rate of disappearance) in ICU patients with severe sepsis/septic shock with normal (<2mmol/L) or elevated (>3mmol/L) levels of lactate. After recruitment and informed consent subjects will receive a femoral venous catheter and infusions of labeled lactate and phenylalanine will start. After reaching steady state concentration blood samples will be drawn from arterial and femoral lines and blood flow in the femoral artery will be assessed using Doppler ultrasound. Data from patients charts will be collected and they will be followed for 28-day mortality. Through this project we will be able to describe lactate metabolism in whole body as well as in the leg. Hopefully this increased knowledge will deepen our understanding and help us to optimize the use of lactate for clinical decision making in the future.

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