Point-of-care measurement of blood lactate in children admitted with febrile illness to an African District Hospital

Clin Infect Dis. 2011 Sep;53(6):548-54. doi: 10.1093/cid/cir471.


Background: Lactic acidosis is a consistent predictor of mortality owing to severe infectious disease, but its detection in low-income settings is limited to the clinical sign of "deep breathing" because of the lack of accessible technology for its measurement. We evaluated the use of a point-of-care (POC) diagnostic device for blood lactate measurement to assess the severity of illness in children admitted to a district hospital in Tanzania.

Methods: Children between the ages of 2 months and 13 years with a history of fever were enrolled in the study during a period of 1 year. A full clinical history and examination were undertaken, and blood was collected for culture, microscopy, complete blood cell count, and POC measurement of blood lactate and glucose.

Results: The study included 3248 children, of whom 164 (5.0%) died; 45 (27.4%) of these had raised levels of blood lactate (>5 mmol/L) but no deep breathing. Compared with mortality in children with lactate levels of ≤ 3 mmol/L, the unadjusted odds of dying were 1.6 (95% confidence interval [CI].8-3.0), 3.4 (95% CI, 1.5-7.5), and 8.9 (95% CI, 4.7-16.8) in children with blood lactate levels of 3.1-5.0, 5.1-8.0, or >8.0 mmol/L, respectively. The prevalence of raised lactate levels (>5 mmol/L) was greater in children with malaria than in children with nonmalarial febrile illness (P < .001) although the associated mortality was greater in slide-negative children.

Conclusions: POC lactate measurement can contribute to the assessment of children admitted to hospital with febrile illness and can also create an opportunity for more hospitals in resource-poor settings to participate in clinical trials of interventions to reduce mortality associated with hyperlactatemia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anemia / blood
  • Bacterial Infections / blood
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Fever / blood*
  • Hospitals / statistics & numerical data
  • Humans
  • Infant
  • Lactic Acid / blood*
  • Logistic Models
  • Malaria, Falciparum / blood
  • Male
  • Mortality
  • Point-of-Care Systems*
  • ROC Curve
  • Risk Factors
  • Tanzania


  • Lactic Acid