Background: 
In consultation with Quality & Patient Safety, and the Sepsis Task Force, the Department of Pathology & Laboratory Medicine will update the normal range for Lactic Acid, Plasma to 0.5 - 2.0 mmol/L. Values greater than 2.0 mmol/L will be flagged as abnormal and the following comment will appear:

Sepsis screening alert:

• If initial lactate > 2.0 mmol/L, repeat level within 2 hours and consider severe sepsis.
• If initial lactate > or = 4.0 mmol/L, repeat level within 2 hours and consider possible septic shock.

Effective date: May 29, 2019

As a reminder, if there is concern for sepsis, severe sepsis or septic shock, the Sepsis Task Force recommends to complete the following tasks within 3 hours in accordance with Centers for Medicare & Medicaid Services Severe Sepsis/Septic Shock: Management Bundle:

• Blood culture, 2 sets (prior to start of antibiotics) [NOTE: Obtain 10mL per bottle]

• Broad-spectrum intravenous antibiotics

• Bolus 30ml/kg of crystalloid fluid (if SBP <90mmHg or lactate ≥4.0 mmol/L)

• Documentation of date/time of onset of sepsis, severe sepsis or shock, any patient or family refusal of care, and response to fluid bolus if administered.

If sepsis was initially considered as a diagnosis causing clinical symptoms but later ruled out, clearly document that in the medical record.

Antimicrobial therapy guidelines for severe sepsis/septic shock may be found on the intranet:

https://intranet.ha.uci.edu/sites/OCM/Clinical%20Pathways/Clinical%20Pathways%20-%20Default/Antimicrobial-Therapy-Guidelines-for-Severe-Sepsis-or-Septic-Shock.pdf 

Specimen requirement and testing information:

Specimen: Collect 4.0 mL whole blood in a grey-top tube (Sodium Fluoride/Potassium Oxalate). Invert tube 8-10 times to properly mix. Improper or delayed mixing may affect results. Do not shake. Spin down and separate plasma from cells within 2 hours of sample collection. Blood should be drawn from a stasis-free vein.

Test methodology: Enzymatic

Test code: LACTAT
 

Stability:

Uncentrifuged whole blood: