![]() The possibilities of lactate measurement with POCT devices at the bedside of patients in the ED and Critical Care are also explored in the literature. Noticeably, the cut-off value of lactate used to predict fetal metabolic acidosis differs strongly between the studies (5.1 mmol/L versus 6.6 mmol/L), which is primarily explained by the use of different analyzers. Recently, these conclusions were confirmed in a large study population resulting in a strong reduction in failure rates, compared with fetal scalp blood sampling, mainly caused by a shortage of sample resulting in no measurement on blood gas analyzers. The StatStrip Lactate was found to perform the best, based on interference studies and imprecision (coefficient of variation, CV) measurements. Frequently evaluated lactate POCT devices are strip-analyzers, like the Lactate-Pro (Arkray) and StatStrip Lactate (Nova Biomedical), which have been shown to have satisfactory analytical performance. ![]() To evaluate the analytical performance of lactate POCT devices in this setting, several studies have compared lactate concentrations in umbilical cord and fetal scalp blood. The common conclusion of these studies is that lactate concentrations represent fetal status equivalently to pH measurement. A number of studies have evaluated whether lactate can replace pH, measured in umbilical cord or fetal scalp blood,. Since lactate is responsible for metabolic acidosis and, moreover, can be measured in very small volumes of blood (1 μL), direct measurement of lactate is a very attractive alternative. However, a major drawback is the amount of sample needed to perform full blood gas analysis (40–90 μL), which results in very high failure rates, up to 23%. It is necessary to distinguish between respiratory and metabolic acidosis, as poor neonatal outcome is associated with the latter. Blood tests include fetal pH, combined with other blood gas parameters (base excess, pCO 2) to identify fetal acidosis. Currently, along with intra-partum cardiotocography to measure fetal heart rate and uterine activity, fetal scalp blood can be collected to monitor fetal status. ![]() In the department of Obstetrics, fetal lactate is a direct indicator of metabolic acidosis and can therefore be used to assess the need for intervention during labor. Measurement by POCT devices can be an adequate method to achieve this, but one should always consider analytical performance, user competences and costs-benefits ratios. A short turn-around-time for lactate measurements, preferably as a component of full blood gas analysis, will support prompt medical decision making. In critically ill patients lactate concentrations are reported to correlate well with disease state, have prognostic value and can be used for monitoring. In the Emergency Department (ED) it can indicate sepsis and ischemia. In case of severe sepsis, lactate is produced by micro-organisms, as these do not have mitochondria.īlood lactate is an indicator for metabolic acidosis and can serve as a single marker for immediate medical intervention. Intracellular produced lactate is secreted as lactic acid, resulting in metabolic acidosis. ![]() In the absence of oxygen, glucose is converted into lactate, while normally glucose is fully oxidized in the cell mitochondria to efficiently produce energy (adenosine triphosphate, ATP). Lactate is a crucial metabolite produced under stress conditions, like hypoxia.
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