Lactic Acid, Lactate (lab test)
Also Consider: Fever
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Causes of elevated levels
Common: hypoxia, heart failure, shock, sepsis
Less common: liver disease, kidney disease, severe anemia
1. Take Vital Signs
Temperature:
Blood Pressure:
Heart Rate:
Respiratory Rate:
Oxygen Saturation:
2. Evaluate Symptoms and Signs
Acute mental status change
Not eating or drinking as much as usual
Acute decline in ADL abilities
Respiratory: New cough, abnormal lung sounds, Accessory muscle breathing, pursed lip breathing, Respiratory distress
Cardiovascular: Chest pain, new irregular pulse, cyanosis, mottling, edema
GI: Nausea, vomiting, diarrhea, abdominal distention or tenderness, rebound tenderness, bowel sounds
GU: New or worsened incontinence, pain with urination, blood in urine, urinary retention / bladder scan
Neurologic changes: consciousness/alertness, orientation, weakness, gait changes (unsteadiness, loss of coordination or balance)
Very low urinary output (<30cc/hr)
Skin: sweats (diaphoresis), cold/clammy/pale skin; any new skin condition, i.e., bruising (including potential head trauma), rash, infection/cellulitis
Fingerstick glucose (patients with diabetes)
3. Take Action using SBAR Report:
Presence of other, significant symptoms or signs of illness
Refer to appropriate Situation-Specific Evaluation for the identified symptoms and signs.
Immediately notify the medical staff & resident representative
Lactic Acid >4.0 mmol/L or >36 mg/dl
Notify medical staff & resident representative within the next 16 hours.
Elevated Lactic Acid level
Notify medical staff at the next regular rounds
Normal Lactic Acid level
SBAR Report
Situation: "Elevated Lactic Acid level of ___ associated with:" (acute symptoms)
Background:
Reason the patient is in the nursing home (rehab for___, long term care for __).
Reason the test was done
When the problems started, how severe they are, getting worse or staying the same, what treatments have been used.
Abnormal vital signs
MOLST / Advance Directives
General observation of patient condition
Very low urinary output (<30cc/hr)
Diet restrictions, fluid restriction, thickened liquids
Blood glucose, if elevated
Abnormal findings on lung, cardiovascular, abdomen, neurologic or skin observations.
Tube feeding rate, water flush orders, residual measurements, recent changes
Availability of IV or clysis hydration (i.e., PICC line)
Assessment: I am concerned about: __________
Recommendations/Requests:
Labs: CBC with manual diff, CMP/Chem14, Blood cultures, Drug levels
INR if patient is on warfarin
Chest X-ray with lateral view if possible
Antibiotic if infection is diagnosed
Straight catheterization for urine sample for urinalysis and culture (unless patient is able to collect clean-catch, midstream urine)
“Hold” parameters for medicines that lower blood pressure
Stool culture and C diff testing if diarrhea is present.
IV or SC (clysis) fluids
Increase tube feed water flushes
Change fluid restriction orders
Other:
Clarify expectations for care, interventions, and illness course/prognosis. Repeat any telephone orders back to the provider to ensure that they are correct and complete
4. Implement Management Plan
Monitor vital signs every 4-8 hrs for 2-3 days
Offer fluids frequently
Oral, IV, or subcutaneous fluids if needed for hydration
Place on Intake & Output monitoring
Monitor meal acceptance
Place on 24-hour report for 2-3 days
Obtain lab results (if ordered), and notify medical as needed of:
Significantly abnormal values in lab tests (refer to appropriate Situation)
Infiltrate or pneumonia on chest x-ray
Positive C. Diff
Urine results suggest infection and symptoms or signs present (Refer to “UTI” Situation)
Implement infection control measures if indicated
Update care plan regarding fall risk, pressure ulcer prevention, assistance needed with ADLs, supervision for safety, restorative needs
Review status and plan of care with designated representative daily or with any changes
Update advance directives if appropriate
2025-04-27
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