Summary by: Rosy Wang Lactate has been viewed as a byproduct of anaerobic metabolism and an indicator of tissue hypoperfusion since the 1900s. This theory is still widely believed. Paul busts the myths surrounding lactic acidosis, anaerobic metabolism, tissue hypoxia and the role of lactate in sepsis. Key take-away facts include: - The production of lactate actually consumes hydrogen ions. Lactic acidosis is really lactic alkalosis. - Lactate is produced physiologically and is a precursor for gluconeogenesis. - During exercise, skeletal muscle exports lactate as the primary fuel for the heart and brain. - At VO2max, intracellular oxygen stays the same. Anaerobic metabolism in cells only occur as a pre-terminal event. The exception is in complete arterial occlusion. - Adrenaline promotes lactate production - Lactate infusion has been shown to increase cardiac output in septic and cardiogenic shock - Lactate is a survival advantage!