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Epic Test Code Sepsis Order Set POCT Lactic Acid for Severe Sepsis

Important Note

THIS IS TO BE ORDERED IN THE SEPSIS ORDER SET AVAILABLE IN EPIC

Specimen Type

Whole Blood

Preferred Container

Heparinized blood gas syringe

 

Collection of a satisfactory specimen for lactate analysis requires special procedures to prevent changes in lactate while and after the specimen is drawn. The patient should be fasting and at complete rest. Blood is best collected without stasis in a heparinized container without a tourniquet or fist clenching, followed by immediate testing of the specimen.

Minimum Volume

0.1 mL

Transportation Needs

Immediate chilling and delivery of the specimen to the laboratory is essential to ensure optimum specimen integrity. 

Reference Values

Type Reference Range Critical Value Units
Venous 0.9 - 1.7 > 3.9 mmol/L
Arterial 0.4 - 1.3 > 3.9 mmol/L

 

*Whole blood values are ~7% lower than plasma values*

Methodology

Abbott iSTAT

CPT Code

83605 and/or 82803

Last Updated

20-Aug-19

Container for iSTAT

Green top or heparinized syringe or blood gas syringe 

 

If sent to laboratory - send on ice without needle

Volume Required

0.5 mL 

Days of Analysis

All

Causes for Rejection

Mislabeled or unlabeled specimen Specimen not received in heparinized container  Clotted specimen  Specimen not analyzed within 30 minutes  No Add-ons 

Available STAT

Yes

Limitations

D-lactate is available as a send-out. Urine is the preferred specimen.   Intravenous injection of epinephrine, glucose, bicarbonate, or other infusions that modify the acid-base balance causes elevation in lactate (and also pyruvate) levels not necessarily related to hypoxia   Grossly hemolyzed samples will give increased LA results due to the presence of lactic acid in the red blood cells.

This method is susceptible to cross reactivity from glycolate. Lactic acid may be elevated in the presence of ethylene glycol ingestion.

 

Patient Preparation

Patient should not exercise prior to collection   The patient should be fasting and at complete rest    Do not use tournqiuet when collecting blood    Do not allow patient to clench their fists durings collection