The Test Sample
What is being tested?
Lactate is one of the substances produced by cells as the body turns food into energy (cell metabolism). Depending on pH, it is sometimes present in the form of lactic acid. However, with the neutral pH maintained by the body, most of it will be present in the blood in the form of lactate. This test measures the amount of lactate in the blood or, less commonly, in the cerebrospinal fluid (CSF).
Normally, the level of lactate in blood and CSF is low. Lactate is produced in excess by muscle cells, red blood cells, brain, and other tissues when there is insufficient oxygen at the cellular level or when the primary way of producing energy in the body's cells is disrupted. Excess lactate can lead to lactic acidosis.
The principal means of producing energy within cells occurs in the mitochondria, tiny power stations inside most cells of the body. The mitochondria use glucose and oxygen to produce ATP (adenosine triphosphate), the body's primary source of energy. This is called aerobic energy production.
Whenever cellular oxygen levels decrease and/or the mitochondria are not functioning properly, the body must turn to less efficient energy production to metabolize glucose and produce ATP. This is called anaerobic energy production and the primary byproduct is lactic acid, which is processed (metabolized) by the liver.
Lactic acid can accumulate in the body and blood when it is produced faster than the liver can break it down.
Excess lactate may indicate one or a combination of the following:
- Lack of oxygen (hypoxia)
- The presence of a condition that causes increased lactate production
- The presence of a condition that causes decreased clearance of lactate from the body
When lactic acid production increases significantly, the affected person is said to have hyperlactatemia, which can then progress to lactic acidosis as more lactic acid accumulates. The body can often compensate for the effects of hyperlactatemia, but lactic acidosis can be severe enough to disrupt a person's acid/base (pH) balance and cause symptoms such as muscular weakness, rapid breathing, nausea, vomiting, sweating, and even coma.
There are a number of conditions that can cause high levels of lactate. See the "What does the test result mean?" section for more.
How is the sample collected for testing?
A blood sample is obtained by inserting a needle into a vein in the arm. Sometimes, an arterial sample is collected by inserting a needle into an artery. Occasionally, a sample of cerebrospinal fluid is collected from the spinal column during a procedure called a spinal tap.
Blood lactate levels will usually be drawn either without the use of a tourniquet or with a tourniquet that is not released during the blood draw. Tourniquet use and release and clenching of the fist can increase lactate levels in the blood sample.
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.
Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
Is any test preparation needed to ensure the quality of the sample?
In general, no test preparation is needed. In some cases, a health practitioner may request that you rest prior to the collection. Rarely, fasting is requested.