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Comment & Response
June 16, 2015

Cause of an Elevated Lactate Level

Author Affiliations
  • 1Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
JAMA. 2015;313(23):2381. doi:10.1001/jama.2015.5043

To the Editor An article in the Diagnostic Test Interpretation series discussed elevated lactate levels in a non–critically ill patient.1 We wish to underscore the importance of considering infection as a cause of lactic acidosis early in the clinical course of similar patients.

Infection is one of the leading causes of death in non-Hodgkin lymphoma2; patients with lymphoma can become immunocompromised as a consequence of the underlying cancer or secondary to myeloablative therapies. Although this patient was not currently neutropenic, his absolute lymphocyte count of 200/μL was very low. A history of advanced, refractory lymphoma and signs of immune suppression should increase clinical suspicion for infection.