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February 24, 2015

Inconsistent Units of Measure

JAMA. 2015;313(8):858. doi:10.1001/jama.2015.334

In the Diagnostic Test Interpretation entitled “Lactate in Sepsis” published in the January 13, 2015, issue of JAMA (2015;313[2]:194-195. doi:10.1001/jama.2014.13811), lactate levels were inserted in both SI and conventional units of measure. In the first paragraph, the second sentence should read “He was found to be tachycardic, hypotensive, in severe respiratory distress, and oliguric, and he had peripheral cyanosis and a lactate level of 3.1 mmol/L (reference range, 0.6-1.7 mmol/L) (27.9 mg/dL; reference range, 5.0-15 mg/dL).” The fourth sentence should read “Following admission, the patient’s lactate level decreased to 1.2 mmol/L (10.8 mg/dL).” The sixth and seventh sentences should read “The following morning, his central venous pressure was 13, stroke volume variation was 7%, and lactate was 3.0 mmol/L (27.0 mg/dL). Mean arterial pressure of 60 to 65 mm Hg was achieved but lactate continued to increase to 4.2 mmol/L (37.8 mg/dL).” In the Test Characteristics section, the first sentence in the first paragraph should read “Studies in hypoxia, low flow states, and early septic shock1 have provided grounds to conceptualize hyperlactatemia (arterial or venous blood lactate >2 mmol/L [>18.0 mg/dL]), as the manifestation of inadequate oxygen delivery and anaerobic metabolism.” The first sentence in the second paragraph should read “Lactate testing is inexpensive (mean Medicare reimbursement, $13.92) and predicts hospital mortality (likelihood ratio, 1.4-2 for ≥2.5 mmol/L [≥22.5 mg/dL]-cutoff; or 2.6-6.3 for 4 mmol/L [36.0 mg/dL]-cutoff).3,4” In the Application of Test Results to This Patient section, the first sentence should read “On admission, a lactate level of 3.1 mmol/L (27.9 mg/dL) should alert the clinician to the high severity of illness.” This article was corrected online.