Understanding Elevated Lactate (Hyperlactatemia) and Lactic Acidosis: This resource provides crucial information for healthcare professionals on diagnosing, documenting, and coding elevated lactate levels. Learn about the causes, symptoms, and treatment of hyperlactatemia, including relevant medical coding terms for accurate clinical documentation and improved patient care. Explore best practices for lactate testing and interpretation in various clinical settings.
Also known as
Disorders of acid-base balance
Covers lactic acidosis, a condition with elevated lactate.
Other abnormal findings of blood chemistry
Includes abnormal lactate levels if not specifically lactic acidosis.
Aplastic and other anemias
Elevated lactate can be a finding in some severe anemias.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the elevated lactate due to a DKA coma?
Yes
Code E13.10, Diabetic ketoacidosis with coma
No
Is the patient in shock?
When to use each related code
| Description |
|---|
| High blood lactate levels. |
| Low blood pH due to lactate. |
| Low tissue oxygenation. |
Coding requires specific lactate levels for accurate severity assignment and differentiation from borderline elevation.
Failure to code underlying causes (e.g., sepsis, metformin use) leads to incomplete clinical picture and inaccurate risk adjustment.
Miscoding hyperlactatemia as lactic acidosis or vice versa based on pH level impacts severity and treatment documentation.
Q: What are the most common differential diagnoses to consider in a patient presenting with elevated lactate levels in the emergency department?
A: Elevated lactate, or hyperlactatemia, in the emergency department can indicate a variety of underlying conditions. A systematic approach to differential diagnosis is crucial. Type A hyperlactatemia, resulting from inadequate tissue oxygenation, is the most common and encompasses causes like septic shock, cardiogenic shock, hypovolemia, severe anemia, carbon monoxide poisoning, and acute respiratory distress syndrome. Type B hyperlactatemia, occurring without global tissue hypoxia, can be caused by conditions such as liver disease, renal failure, certain medications (e.g., metformin, nucleoside reverse transcriptase inhibitors), thiamine deficiency, malignancies, and inborn errors of metabolism. Finally, other causes include regional hypoperfusion (e.g., limb ischemia), intense muscular activity, and seizures. Accurate diagnosis requires careful clinical evaluation, including a thorough history, physical exam, and targeted laboratory testing. Explore how point-of-care lactate measurement can aid in rapid assessment and management of critically ill patients.
Q: How do I interpret an elevated lactate level in conjunction with other clinical findings, such as pH and bicarbonate, to distinguish between hyperlactatemia and lactic acidosis?
A: While hyperlactatemia simply refers to an elevated blood lactate concentration (typically >2 mmol/L), lactic acidosis specifically denotes hyperlactatemia accompanied by a decrease in arterial pH (<7.35) due to lactate accumulation. Differentiating between the two requires integrating lactate levels with other acid-base parameters like pH and bicarbonate. An elevated lactate with a normal or near-normal pH and bicarbonate suggests hyperlactatemia without acidosis, which can still warrant further investigation depending on the clinical context. However, a low pH combined with an elevated lactate and decreased bicarbonate indicates lactic acidosis, signifying a more severe metabolic disturbance. The anion gap can provide further insight; an elevated anion gap often points towards lactic acidosis as the underlying etiology. Consider implementing an acid-base nomogram to help visualize and interpret these interrelated parameters. Learn more about the pathophysiology of lactate metabolism and its implications for clinical management.
Patient presents with elevated lactate levels, also known as hyperlactatemia, indicating a potential state of lactic acidosis. The patient's lactate level was [insert numerical value and units, e.g., 5.2 mmol/L]. Symptoms include [document specific symptoms observed, e.g., tachypnea, tachycardia, altered mental status, hypotension, abdominal pain, nausea, vomiting]. Differential diagnosis includes sepsis, hypoperfusion, tissue hypoxia, mitochondrial dysfunction, medication side effects (e.g., metformin, nucleoside reverse transcriptase inhibitors), thiamine deficiency, and inherited metabolic disorders. Initial assessment includes a complete blood count, comprehensive metabolic panel, arterial blood gas analysis, and blood cultures to identify the underlying cause. Treatment focuses on addressing the underlying etiology of the elevated lactate. Fluid resuscitation is initiated to address potential hypovolemia. Oxygen therapy is administered as needed to improve tissue oxygenation. Further management may include vasopressors to support blood pressure, antibiotics for suspected infection, or other interventions based on the specific cause. Monitoring of lactate levels, vital signs, and clinical status is essential to evaluate treatment effectiveness. ICD-10 code E87.2 (disorders of acid-base balance, not elsewhere classified) may be applicable, depending on the specific clinical context and etiology of the hyperlactatemia. CPT codes for relevant laboratory tests and procedures will be documented separately, such as 82565 for lactate measurement and 9928[X] for emergency department visits, where X corresponds to the level of service. Ongoing monitoring and treatment will be adjusted based on the patient's response and identified underlying cause. This hyperlactatemia diagnosis is considered medically necessary based on the patient's presenting symptoms, laboratory results, and clinical findings.