Lactate, an Essential Metabolic Marker in the Diagnosis and Management of Pediatric Conditions

Abstract

Measurement of circulating lactate is an essential diagnostic tool in pediatric medicine, playing a crucial role in assessing metabolic status and tissue oxygenation. Initially regarded as a byproduct of anaerobic metabolism, recent research has expanded our understanding of lactate's roles across various physiological systems, from energy metabolism to immune modulation and neurological health. Elevated lactate levels are widely utilized to monitor critical conditions such as sepsis, trauma, and hypoxic-ischemic injury, offering valuable prognostic information in intensive care settings. Notably, lactate dynamics-particularly trends in serial measurements-are more effective than single readings for predicting clinical outcomes, especially in sepsis and trauma. Measurement of circulating lactate in different body fluids (blood, cerebrospinal fluid, and umbilical blood) provides critical insights into neonatal health and central nervous system involvement. However, challenges remain, including the need for non-invasive and rapid point-of-care testing, particularly in neonatal populations. Our aim was to review and synthesize the current literature on the role and particularities of measurement of circulating lactate in pediatric pathology. Emerging technologies, such as machine learning models and small molecule inhibitors, show promise in advancing lactate regulation and predicting hemodynamic instability. As the role of lactate in pediatric pathology continues to evolve, optimizing measurement protocols and exploring new therapeutic strategies will enhance early detection, intervention, and clinical outcomes for critically ill children.

Keywords: anaerobic metabolism; lactate; metabolic status; pediatric disease; predicting clinical outcomes.

Figure 1

Differential diagnosis of metabolic acidosis—focus on hyperlactatemia. PDH—pyruvate dehydrogenase, PC—pyruvate carboxylase, GSD I—glycogen storage disease type I. Created with BioRender.com (accessed on 12 December 2024).