Table 6.
Biochemical clues to differential diagnosis of elevated lactate levels
| Lactate (fasting) | Lactate (after meal) | Lactate/ Pyruvate (fasting) | Ketones | Blood Glucose (fasting) | Disorder |
|---|---|---|---|---|---|
| (N−) ↑↑↑ | (Rise) | (N−) ↑↑ | (↑)- ↑↑ | N | Respiratory chain defect |
| (N−) ↑↑↑ | Rise | N | N | N | Pyruvate dehydrogenase deficiency |
| (N−) ↑↑↑ | Fall | (N−) ↑ | ↑↑ | (↓) | Pyruvate carboxylase defect |
| (N−) ↑↑↑ | Rise | N | (N−)↑ | ↓↓ | Gluconeogenesis, GSD I |
| N | (Rise) | N | ↑-↑↑ | ↓↓ | GSD types III, 0 |
| N− ↑ | (Fall) | N | ↓↓ | ↓↓ | Fatty acid oxidation defects |
| (N−) ↑↑ | (Rise) | (N−) ↑↑ | ↑-↑↑ | ↓-↑ | Organic acidurias |
N: Normal, (): Inconstant, ↑: Increased, ↓: Reduced, GSD I, III and 0: Glycogen storage disorder types I, III and 0