Not all raised lactate is sepsis or hypoperfusion! Watch this video to learn about the Lactate Map and a killer acronym to help you avoid missing the important causes of elevated lactate
This information here should be provided to everyone who works in acute medicine. Thank you very much for your efforts. As an ICU expert, i understand the importance of this information.
Monitoring of Co-factor thiamine is helpful for patients before infusion of pharmaceutical lactate Crystalloidals giving negative feedback inhibition hyperventilation.
From non science background you made me understand it so beautifully. It will be great if some one can tell me how can we have enough oxygen for pyruvate to go towards PDH than Acetyl CoA. I see extreme high lactate in my OAT report
Thank you so much sir, I came to learn more about raise lactate after learning about a patient that was given fluid due to raise lactate, and subsequently went into fluid overload. Your explanation has made life easy. Thank you
Doctors killed my mom in the ICU ,she most likely had thiamine deficiency that caused most her problems from all the diabetic drugs causes B1 deficiency and eventually heart failure, enlarged heart etc.....doctors overload her with IV 10 different drugs: dopamine, potassium, magnesium, etc.....AND ONLY 100mg of thiamine 3 times a day. In the studies I've read it say must be doses of 1500mg a day or higher to have benefits in 4 days pacient can be discharged from hospital,also it mentioned Vitamin C as well together with thiamine IT WILL STOP THE PROGRESSION OF SEPSIS!!!!!! for all the doctors out there, if you have to break the rules of the hospitals protocol of treatments to save people's lives THEN YOU MUST DO IT!!! MY mon died because the lack of knowledge of those doctors out there.MOST OF THEM DONT READ RESEARCH and every day kill people because don't want to break rules of hospitals base treatment THAT DOESN'T WORK FOR MOST PEOPLE AND SOME DRIE BECAUSE OF THIS. IF THE BODY IS SICK THE OBVIOUS IS LACK OF CERTAIN NUTRIENTS.
Dear Dr. Read, Thanks for this excellent video. Can you make any recommendations on further key papers/reviews on lactate metabolism in ICU patients - as a supplement to your video. Thank you.
1. Marik PE, Bellomo R. Lactate clearance as a target of therapy in sepsis: A flawed paradigm. OA Critical Care. 2013;1(1). 2. Jansen TC, van Bommel J, Bakker J. Blood lactate monitoring in critically ill patients: A systematic health technology assessment*. Critical Care Medicine. 2009 Oct;37(10):2827-39.
Important to note that in inborn errors of metabolism, the treatment is often glucose infusion.. this causes elevated lactate, and in this case it is just the response to treatment.
Great video thank you. How long can the elevated lactate go on for if it was due to salbutamol please? If the salbutamol use has stopped. Could it last months (tingling in fingers on outbreath for example)?
mrmeach1967 check this out! “Magnesium plays an important role in oxidative metabolism. The conversion of thiamine to its active triphosphate form is reliant on magnesium as a cofactor.9-11 Thiamine pyrophosphate, in conjunction with pyruvate dehydrogenase, is critical in the metabolism of pyruvate to acetyl coenzyme A for entrance into the citric acid cycle.12 In the absence of magnesium, disrupted oxidative phosphorylation shifts toward anaerobic metabolism, resulting in lactic acid production.” www.ncbi.nlm.nih.gov/pmc/articles/PMC4909152/
So basically you f you don’t eat sugar before or after a workout you won’t have a response from pyruvate? No pain? I think this is true because when I eat keto and workout no pain. But it’s f I eat a carbohydrate rich meal after. Workout there is pain.
My son 3.5months old he have Lactate plasma issue 10.7 . Now he is not able to speak🗣 and he is not identifying if say anything he is not able to understand. My docter said it is genetic problem come from mother she said it is not curable. Please suggest it is curable? What steps we need to take to improve my baby
Things have moved on since the pyruvate goes to Acetyl CoA under aerobic circumstances and to lactate in anaerobic conditions hypothesis. There is no oxygen demand for either pathway and no way for oxygen to switch metabolism from one to the other. All pyruvate is now thought to be converted to lactate in the cytosol. This shuttles between cells as needed for energy transfer (see lactate shuttle theory). Lactate that enters the mitochondrial intramembrane space is converted back to pyruvate and then on to Acetyl CoA. Elevated lactate does not signify ischaemia or hypoxia, it signifies a "stressed" metabolism with glycolytic production of lactate exceeding intracellular clearance. If lactate somehow was linked to hypoxia then it would rise under hypoxic conditions and conversely one would find hypoxia where there is high lactate. The former is not seen in Everest submitters who had normal lactates despite SpO2 of as low as 30% and the latter is not seen intracellularly in volunteer athlete's thigh muscles after exercise to failure.
These kinds of videos with real life examples are so much better than reading a boring text book. Thank you Cliff
1:17 Electron transport and shit - love that 👍
This information here should be provided to everyone who works in acute medicine. Thank you very much for your efforts. As an ICU expert, i understand the importance of this information.
Monitoring of Co-factor thiamine is helpful for patients before infusion of pharmaceutical lactate Crystalloidals giving negative feedback inhibition hyperventilation.
Very very informative. Read about lactic alkalosis before and my mind was blown.
Couldn't be better than this!!!! Thank you very much .. great explination made lactate very easy finally !!!
Exactly the information I was looking for. Thank you for the clear and simple lecture :))))))
Brilliant, sir, brilliant! Best discussion of lactate on UA-cam! Don't forget Warburg effect and cancer!
12:21 "Woooow". Very helpful video, thanks!
your voice is soothing to listen to , great video Dr .
Outstanding! Very easy to follow and practical. Thanks.
Thank you so much for this. 👏🏾👏🏾👏🏾
Brilliantly done, thank you 🙏🏻
Great Video, Thanks!
My man this is the best!! Definately going to throw the lactic alkalosis term around! :D
you really nailed that at the end with the "lactates" acronym
great vid.. great info! keep up the great work
Thanks a lot for making this video!
This is great video! Thank you for the effort :)
AMAZING!!! Thank you!
excellent presentation thank you !!
This was outstanding. Thank you so much
Great and practical !
Congratulations
Thank you so much! I am so appreciative of your video it has completely made sense of lactate for me for Blood gas readings.
Thank you
@@CliffReid about to do epls so trying to understand blood gases. This is fab!!
Phenomenal lecture. More ICU related content pls
Best lactate video ever
Nice... Love a good acronym
Wow this vid was really clear and easy to understand thank you
Beautifully summarised
An Amazing presentation!
Thank you for the great video 😊
Wonderful summary. Thank you!
love the mnemonic at the end (& the rest of it, and shit)
Thanks Doc!
This is how you teach!
You are a genius, thanks for the video and the diagram and shit. just subbed.
BRAVO!!!!!
Wooooow really
perfect explanation. thank you
thank you for this video.... if exercise is always done in anaerobic zone.... soon, one will becone unhealthy too
THANK YOU!!!!!
Thank you very much
Thank you! Great visuals! If a patient is full of gut parasites, and/or liver flukes, would that cause LDH levels to rise?
From non science background you made me understand it so beautifully. It will be great if some one can tell me how can we have enough oxygen for pyruvate to go towards PDH than Acetyl CoA. I see extreme high lactate in my OAT report
Excellent video
thank you
Amazing video thanks alott
This is a good video. Lactate is a poor test though. Specimen collection is dicey, and the video explains its nonspecificity.
Thank you so much sir, I came to learn more about raise lactate after learning about a patient that was given fluid due to raise lactate, and subsequently went into fluid overload.
Your explanation has made life easy. Thank you
Doctors killed my mom in the ICU ,she most likely had thiamine deficiency that caused most her problems from all the diabetic drugs causes B1 deficiency and eventually heart failure, enlarged heart etc.....doctors overload her with IV 10 different drugs: dopamine, potassium, magnesium, etc.....AND ONLY 100mg of thiamine 3 times a day. In the studies I've read it say must be doses of 1500mg a day or higher to have benefits in 4 days pacient can be discharged from hospital,also it mentioned Vitamin C as well together with thiamine IT WILL STOP THE PROGRESSION OF SEPSIS!!!!!! for all the doctors out there, if you have to break the rules of the hospitals protocol of treatments to save people's lives THEN YOU MUST DO IT!!! MY mon died because the lack of knowledge of those doctors out there.MOST OF THEM DONT READ RESEARCH and every day kill people because don't want to break rules of hospitals base treatment THAT DOESN'T WORK FOR MOST PEOPLE AND SOME DRIE BECAUSE OF THIS. IF THE BODY IS SICK THE OBVIOUS IS LACK OF CERTAIN NUTRIENTS.
Many doctors themselves don't even know what's wrong with them when they are sick, how would know to treat a patient effectively?? Them can't!
Nice presentation 💎
Thanks 👍
Hi, thanks for the video. I thought that when you hyperventilate your CO2 levels drop?? as your lungs exhale co2?
Excellent
Thiamin and magnesium deficiency can manifest in korsakoff-psychosis and high lactate
Very well explained
Dear Dr. Read,
Thanks for this excellent video. Can you make any recommendations on further key papers/reviews on lactate metabolism in ICU patients - as a supplement to your video.
Thank you.
1. Marik PE, Bellomo R. Lactate clearance as a target of therapy in sepsis: A flawed paradigm. OA Critical Care. 2013;1(1).
2. Jansen TC, van Bommel J, Bakker J. Blood lactate monitoring in critically ill patients: A systematic health technology assessment*. Critical Care Medicine. 2009 Oct;37(10):2827-39.
@@CliffReid Thank You!
Could kidney failure also cause an elevated lactate due to the kidneys inability to excrete the lactate? Great video, thank you!
Important to note that in inborn errors of metabolism, the treatment is often glucose infusion.. this causes elevated lactate, and in this case it is just the response to treatment.
Great video thank you. How long can the elevated lactate go on for if it was due to salbutamol please? If the salbutamol use has stopped. Could it last months (tingling in fingers on outbreath for example)?
No it clears the same day - minutes to hours
This was super helpful! Thanks!
5:43 Thiamine deficiency.
Really thiamine pyrophosphate (TPP), the active form.
mrmeach1967 check this out! “Magnesium plays an important role in oxidative metabolism. The conversion of thiamine to its active triphosphate form is reliant on magnesium as a cofactor.9-11 Thiamine pyrophosphate, in conjunction with pyruvate dehydrogenase, is critical in the metabolism of pyruvate to acetyl coenzyme A for entrance into the citric acid cycle.12 In the absence of magnesium, disrupted oxidative phosphorylation shifts toward anaerobic metabolism, resulting in lactic acid production.”
www.ncbi.nlm.nih.gov/pmc/articles/PMC4909152/
lactic.. akalosis??? dang... thank you
Can you explain elevated levels of lactate in ARDS please?
Mine was not a real concern , slightly elevated, it when it up after my steroid injection
Can high lactic acid levels cause brain fog and affect memory?
Yes I had brain fog and memory problems when I was septic in 2022
My lactate level is 2.95, is it dangerous?
A lactate of 2.7 is worrisome? 5 months ago 1.5 mmol lactate,
Mine is 2.95(((
So basically you f you don’t eat sugar before or after a workout you won’t have a response from pyruvate? No pain? I think this is true because when I eat keto and workout no pain. But it’s f I eat a carbohydrate rich meal after. Workout there is pain.
What happens if you use fat for energy and your glucose is at a minimum
Doc, what about diabetes? . Can it simulate the increase of gluconeogenesis and create exuberant lactate concentration ?
Haven't seen much raised lactate in diabetes without one of the other causes. Found this paper: pamw.pl/sites/default/files/PAMW_2013-3_Krzymien.pdf
Cliff Reid thanks Doc. Cheers from italy. Your. Video is illuminating
Isnt one of the side effects of metphormin...
Muscle pain...
Does the buildup of lactate due to inhibition of gluconeogenesis cause this...
Hi sir I am from India my son is 2 and half years suffering from elivated lactate acid ( IEM) by birth how is life my son pls tell me sir
My son 3.5months old he have Lactate plasma issue 10.7 . Now he is not able to speak🗣 and he is not identifying if say anything he is not able to understand. My docter said it is genetic problem come from mother she said it is not curable. Please suggest it is curable? What steps we need to take to improve my baby
I'm so sorry that isn't my area of expertise. I wish your family well.
Things have moved on since the pyruvate goes to Acetyl CoA under aerobic circumstances and to lactate in anaerobic conditions hypothesis. There is no oxygen demand for either pathway and no way for oxygen to switch metabolism from one to the other. All pyruvate is now thought to be converted to lactate in the cytosol. This shuttles between cells as needed for energy transfer (see lactate shuttle theory). Lactate that enters the mitochondrial intramembrane space is converted back to pyruvate and then on to Acetyl CoA. Elevated lactate does not signify ischaemia or hypoxia, it signifies a "stressed" metabolism with glycolytic production of lactate exceeding intracellular clearance. If lactate somehow was linked to hypoxia then it would rise under hypoxic conditions and conversely one would find hypoxia where there is high lactate. The former is not seen in Everest submitters who had normal lactates despite SpO2 of as low as 30% and the latter is not seen intracellularly in volunteer athlete's thigh muscles after exercise to failure.
ua-cam.com/video/VU_e_02hcLA/v-deo.html
Thank you very much for this
This is why they wanted me to go to the hospital
10:12 about sepsis. Thanks me later. 😊😊
Thank you very much
thank you