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Causes of increased lactate
Last reviewed: 06.07.2025
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An increase in lactate concentration reflects the degree of tissue ischemia. The lactate content in the blood during hypoxic conditions increases in accordance with the severity of hypoxia. Accumulation of lactate is one of the causes of comas, in particular hyperlactacidemic diabetic coma.
The following types of increased lactate (lactic acidosis) in the blood are distinguished.
- Type I: lactate concentration is elevated, severe acidosis is absent, lactate/pyruvate ratio is normal. This type is detected during physical exertion, hyperventilation, glucagon action, glycogenosis, severe anemia, and administration of pyruvate or insulin.
- Type IIA (associated with hypoxia): marked acidosis, elevated lactate concentration, increased lactate/pyruvate ratio. This type is found in any conditions with inadequate oxygen delivery to tissues (acute hemorrhage, severe acute congestive heart failure, cyanotic heart disease or other cases of acute hypoxia, extracorporeal circulation).
- Type IIB (idiopathic): lactate concentration is elevated, acidosis is moderate to severe, lactate/pyruvate ratio is increased. This type is observed in mild uremia, infections (especially pyelonephritis), liver cirrhosis, pregnancy (third trimester), severe vascular diseases, leukemia, anemia, alcoholism, subacute infective endocarditis, poliomyelitis, diabetes mellitus (approximately 50% of cases).
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