الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Lactic acidosis is a broad anion gap metabolic acidosis caused by either overproduction or underutilization of lactate. Overproduction of lactate occurs when the body generates (ATP) while underutilization involves decreased removal of lactic acid by oxidation or conversion to glucose. Lactate also has become established as an important marker for the (ICU), the initial studies showed an increased mortality associated with peak serum lactate levels.The normal blood lactate concentration in an unstressed patient is 1±0.5 mmol/L. Lactate is a byproduct of glycolysis, by an anaerobic process taking place in the cytosol. Lactic acidosis was classified as type A and B according to the cause for increase in lactate level then it was classified later as type I and type II depending upon the relative proportions of lactate and pyruvate . Although circulatory shock is the commonest cause of hyperlactatemia and the presence of increased blood lactate in shock signifies a poor prognosis, Blood lactate levels also have been found to be the earliest predictor of mortality in sepsis, and identify survivors from non survivors 12 hrs after admission. On the other hand serum lactate levels may be a useful predictor of mortality in children less than 1 year of age who have undergone cardiopulmonary bypass, an elevation in serum lactate level after a complex operation for congenital heart disease should be taken as a serious indicator of potential mortality. Also increasing lactate concentrations in mechanically ventilated patients may mean that the patient is ”fighting the ventilator” and admission lactate reflects pre-hospital traumatic shock much earlier than vital signs (HR, BP, respiratory rate, blood pH, and bicarbonate deficit).If we talk about hepatic patients, Lactate levels go up in patients with acute liver failure and have been found to come down after liver transplantation. It also predict the severity of MODS in septic shock patients and was proposed as a pretransfusion screen that would identify early tissue hypoxia in asymptomatic anemia and prevent unnecessary transfusions. So serum lactate levels are a useful tool in monitoring critically ill patients.