IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 19, Issue 5 Ser.6 (May. 2020), PP 20-24 www.iosrjournals.org DOI: 10.9790/0853-1905062024 www.iosrjournal 20 | Page Blood lactate level as a predictor of outcome in pediatric septic shock and its correlation with PRISM III score. Dr. Ashwini Gupta 1 , Dr. Akansha Sharma 2 , Dr. Ravi Sharma 3 , Dr. Anupam Chaturvedi 4 1 DNB, Department of Pediatrics, SDMH, Jaipur, India 2 Senior Resident, SMS Medical College and attached J. K lon hospital, Jaipur, India 3 DCH, ISCCM, Pediatric Intensivist, SDMH, Jaipur, India 4 MD, Honorary Consultant, Department of Pediatrics, SDMH, Jaipur, India Corresponding Author: Dr. Ashwini Gupta --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 02-05-2020 Date of Acceptance: 16-05-2020 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Severe sepsis and septic shock causes significant mortality, morbidity and high cost of care. Traditionally, normalization of vital signs, such as blood pressure, urine output, and heart rate has been used as endpoints of resuscitation. However, critical analysis of these endpoints has revealed the inadequacy of relying solely upon vital signs in resuscitation of critically ill patients 1 . In the presence of normal vital parameters there is persistence of tissue hypoperfusion which leads to MODS and death. 2 Many critically ill patients who are normotensive and have adequate urine output, may remain in a state of compensated shock. 1 The optimal management of pediatric septic shock patients includes early recognition of inadequate tissue perfusion and its timely correction in an effort to prevent anaerobic metabolism, acidosis, and cellular death. 3-5 Lactate is a byproduct of anaerobic metabolism after glycolysis 6 . Lactate is produced in the majority of tissues in human beings, but the main producers include red blood cells, intestine, brain and muscles. 7-8 Several studies have shown an elevated lactate-to-pyruvate ratio in septic shock, suggesting tissue hypoxia is the cause of lactic acidosis. 9 Increased lactate levels may be considered an early marker of a potentially reversible state, e.g., early septic shock, possibly indicating that “there is still room” to boost fast intervention 10 . Single measurement of lactate is a static variable however it can serve as a risk stratification biomarker 11 . Majority of research with blood lactate has been conducted in adults. In literature, there has been paucity of data on lactate as a prognostic marker of mortality in pediatric population with shock. Hence, the present study done to evaluate the prognostic value of lactate in children with septic shock to stratify the management of high risk and to assess mortality. II. Materials and Methods This study was a prospective observational study conducted in the PICU of tertiary care centre of North India, over a period of 18 months. Total 100 cases of septic shock between the ages of 1 month to 17 years were enrolled for the study. Septic shock 12 is defined as confirmed or presumed infection, having two or more systemic inflammatory response criteria and hypoperfusion evidenced by either a systolic blood pressure lower than – 2 standard deviation (SD) adjusted for age or at least one manifestation of inadequate organ perfusion, that is, altered mentation, hypoxia (PaO 2 <45 mmHg while breathing room air or PaO 2 /FiO 2 <350), metabolic acidosis (arterial pH <7.35 or base deficit >5), or oliguria (i.e., urine output <0.5 ml/kg/h), along with signs of poor peripheral perfusion. Following patients were excluded from the study- 1. Other causes of shock, eg- cardiogenic shock, neurogenic shock, anaphylactic shock, dengue shock syndrome, obstructive shock. 2. Patient with known malignancies and immunosuppressive treatment. 3. Other Condition known to cause elevated lactate for example:- a) Chronic medical illness b) Inborn error of metabolism c) Liver disease 4. Post-operative patients