Lactate is produced from anaerobic glycolysis, which occurs in most tissues in the human body. Blood lactate is tested in most physiologically unwell patients in the Emergency Department and helps to guide treatment and prognosis. Cerebrospinal fluid (CSF) lactate, however, is not often measured. Various central nervous system (CNS) conditions lead to a rise in CSF lactate, including acute neurological infection, stroke, seizures and mitochondrial pathologies. This article discusses the utility and limitations of CSF lactate, highlighting specific clinical situations where it can help in the diagnosis of CNS infections and unexplained encephalopathy.
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Contributors AB: Initial draft of the manuscript and concept for paper, subsequent revisions. RP: Review of paper and specialist input on inborn errors of metabolism section. CC: Review of paper and specialist input on infection section. ND: Concept for paper, review of paper and specialist review of neurological infection section.
Funding RDSP is supported by a Medical Research Council Clinician Scientist Fellowship (MR/S002065/1).
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned; externally peer reviewed by Rhys Thomas, Newcastle-upon-Tyne, UK.