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Lactat in der Notfallmedizin

Lactate in emergency medicine

  • Notfallmedizin
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Zusammenfassung

Grundlage für alle metabolischen Prozesse im menschlichen Körper ist die Gewinnung und Verstoffwechselung von Energieträgern. Als Endprodukt der anaeroben Glykolyse entsteht Lactat. Dieses dient dem Körper als Substrat für die Gluconeogenese und als oxidierbares Substrat. Infolge einer Vielzahl an Akutereignissen (z. B. Schock, Sepsis, Herz-Kreislauf-Stillstand, Trauma, Krampfanfall, Ischämie, diabetische Ketoacidose, Thiaminmangel, Leberfunktionsstörungen, Intoxikationen) kann eine Hyperlactatämie nachgewiesen werden. Da eine Hyperlactatämie mit erhöhter Mortalität einhergehen kann, ist in der Notfallmedizin einerseits die Fahndung nach der Ursache der Hyperlactatämie ebenso wichtig wie andererseits eine effektive kausale Therapie. Wiederholte Lactatmessungen sind Bestandteil vieler Behandlungsalgorithmen, da die Betrachtung der dynamischen Entwicklung der Blutlactatkonzentrationen helfen kann, den Akutzustand des Patienten und die Effektivität der getroffenen Maßnahmen besser abzuschätzen.

Abstract

The basis of all metabolic processes in the human body is the production and metabolism of carriers of energy. Lactate is the end-product of anaerobic glycolysis. Lactate can serve as a substrate for gluconeogenesis and as an oxidation substrate. Hyperlactatemia can be detected as the result of a multitude of acute events (e.g. shock, sepsis, cardiac arrest, trauma, seizure, ischemia, diabetic ketoacidosis, thiamine deficiency, liver failure and intoxication). Hyperlactatemia can be associated with increased mortality, therefore in emergency medicine the search for the cause of hyperlactatemia is just as important as an effective causal treatment. Repetitive measurements of lactate are components of several treatment algorithms as observation of the dynamic development of blood lactate concentrations can help to make a better assessment of the acute medical condition of the patient and to evaluate the effectiveness of the measures undertaken.

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Authors and Affiliations

  1. Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland

    Andre Kramer

  2. Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    Sascha Al Agha, Lennert Böhm, Mark Michael &  Michael Bernhard

  3. Zentralinstitut für Klinische Chemie und Laboratoriumsdiagnostik, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    Karin Schulze-Bosse

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  1. Andre Kramer
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  2. Sascha Al Agha
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  3. Lennert Böhm
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  4. Mark Michael
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  5. Karin Schulze-Bosse
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Correspondence to Michael Bernhard.

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Interessenkonflikt

A. Kramer, S. Al Agha, L. Böhm, M. Michael, K. Schulze-Bosse und M. Bernhard geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Kramer, A., Al Agha, S., Böhm, L. et al. Lactat in der Notfallmedizin. Anaesthesist 69, 826–834 (2020). https://doi.org/10.1007/s00101-020-00819-1

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