Abstract
Blood lactate concentrations have been used as a marker of tissue hypoperfusion in circulatory shock for over 30 years.1 The rise in lactate concentration correlates with total oxygen debt and with decreases in high-energy phosphates. Under aerobic conditions, 1 mole of glucose is metabolised to pyruvate, which, after conversion to acetyl-coenzyme A, enters the tricarboxylic acid (Krebs) cycle and is oxidised to carbon dioxide with the production of a total of 38 moles of ATP. By contrast, under anaerobic conditions, pyruvate is converted to lactate via the Embden-Meyerhof (glycolytic) pathway, and only 2 moles of ATP are produced per mole of glucose.
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