On the origins of lactate during sepsis.

The origins of sepsis-induced hyperlactatemia are still imperfectly understood and probably multifactorial, resulting both from an increased production by various tissues through aerobic and anaerobic glycolysis, and from a decreased lactate clearance. In the previous issue of Critical Care, Michaeli and colleagues showed that lactate elevation during mild endotoxemia is due to an increased aerobic production that does not take place in the muscle; other tissues/cells may thus be important contributors.