Arterial lactate concentration, hospital survival, sepsis and SIRS in critically ill neonatal foals.
Authors: Corley K T T, Donaldson L L, Furr M O
Journal: Equine veterinary journal
Summary
# Editorial Summary Arterial lactate concentration has proven valuable in human critical care but remained formally unevaluated in sick foals until Corley and colleagues examined 72 neonatal foals admitted to intensive care, measuring lactate at admission and again at 18–36 hours post-admission. Admission lactate concentrations above 2.5 mmol/l were present in 61 foals and demonstrated significant associations with hospital survival, mean arterial pressure, blood creatinine, bacteraemia, anion gap, and systemic inflammatory response syndrome (SIRS)—providing objective prognostic indicators beyond clinical assessment alone. Notably, lactate measurements at 18–36 hours also correlated with survival and SIRS markers, whereas surrogate markers such as anion gap, base excess and bicarbonate correctly identified hyperlactaemia (>5 mmol/l) in fewer than 80% of cases, demonstrating they cannot reliably substitute for direct lactate measurement. For equine practitioners managing critically ill foals, this research underscores that arterial lactate warrants routine measurement at admission as a prognostic tool and suggests serial monitoring may reveal therapeutic responses that other acid-base parameters miss. Further investigation into how lactate changes track treatment efficacy could refine prognostication and guide clinical decision-making in neonatal intensive care.
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Practical Takeaways
- •Measure arterial lactate directly in critically ill neonatal foals at admission and 18-36 hours post-admission, as it provides important prognostic information for survival prediction
- •Do not rely on anion gap, base excess, or bicarbonate calculations to estimate lactate concentration; direct measurement is significantly more accurate for identifying hyperlactaemia
- •Elevated admission lactate correlates with sepsis, SIRS, and hemodynamic compromise (low MAP, elevated creatinine), making it a useful marker for severity assessment in intensive care foals
Key Findings
- •Admission arterial lactate >2.5 mmol/l was present in 61 of 72 foals and was significantly associated with hospital survival
- •Admission lactate concentration correlated with mean arterial pressure, blood creatinine, bacteraemia, anion gap, and evidence of SIRS
- •Lactate at 18-36 hours post-admission was also associated with survival and SIRS presence
- •Anion gap, base excess, and bicarbonate correctly classified hyperlactaemia (>5 mmol/l) in ≤80% of cases, indicating lactate should be directly measured rather than assumed