Investigating lactate metabolism in critically ill patients whom are hypoperfused by preforming metabolomics via liquid chromatography-mass spectrometry.

Lactate concentration is well known to be directly correlated with risk of death during admission to intensive care. However, lactate by itself is not considered toxic. The study is observational. The breakdown of lactate is being investigated by collecting blood- and urinsamples from patients with hyperlactatemia as a result of hypoperfusion. Levels of lactate, and known as well as unknown metabolites will be identified and quantified by metabolomics. Metabolomics is performed using a combination of liquid chromatography and mass spectrometry. Data will be analysed via statistical analysis to investigate corelations between lactate, a given metabolite and hard outcome such as mortality. And thereby lay the groundwork for potential further research regarding specific lactate-metabolites.

Inclusion Criteria:

• Diagnosed with sepsis/septic shock or severe heart failure.
• Clinical and paraclinical signs of hypoperfusion in relation to abovementioned diagnosis.
• Metabolic acidosis with s-lactate equal-to-or-above 4 mmol/l.
• Incapacitated

Exclusion Criteria:

• Only regional hypoperfusion such as a leg.
• Receiving intravenous lactate as part of treatment.
• Going in to dialysis. The exclusion is only during dialysis treatment.

A broad spectrum of patients will make up for the population of the study. These are critically ill adults who are admitted to the intensive care unit of Hvidovre Hospital.