Epinephrine-Induced Lactate Production

Mechanisms of Lactate Production

Epinephrine stimulates beta-2-adrenergic receptors in skeletal muscle, activating glycogenolysis and glycolysis, leading to increased lactate production 1
At lower infusion doses (<0.3 μg/kg/min), epinephrine predominantly produces beta-adrenergic effects, including increased lactate production in peripheral tissues 2
In skeletal muscle, beta-adrenergic stimulation activates glycogenolysis and increases lactate production due to the absence of glucose-6-phosphatase 3

Epinephrine can cause increased plasma lactate independent of changes in organ perfusion, making lactate a more difficult parameter to interpret in patients receiving epinephrine 1
In comparative studies, epinephrine infusion produced a transient increase in serum lactate levels and decrease in arterial pH compared to norepinephrine 3
When using epinephrine in clinical settings, particularly in septic shock, clinicians should be aware that elevated lactate may not necessarily indicate worsening tissue perfusion 1, 4
Lactate-guided resuscitation strategies should consider the direct metabolic effects of epinephrine when interpreting lactate levels 4, 5

At lower doses (<0.3 μg/kg/min), epinephine primarily causes beta-adrenergic effects with greater lactate production 2
At higher doses (>0.3 μg/kg/min), alpha-adrenergic vasoconstriction becomes more prominent, though metabolic effects persist 2, 6

The American College of Critical Care Medicine suggests that epinephrine may prevent the use of lactate clearance to guide resuscitation because elevated lactate does not necessarily indicate worsening tissue perfusion, with a relative risk of 0.96 and 95% confidence interval of 0.77-1.21 7
Major guidelines, such as those from the American College of Critical Care Medicine, recommend norepinephrine as first-line therapy for septic shock, with epinephrine as the first alternative when norepinephrine is unavailable or ineffective, based on randomized trials with no mortality difference between the two agents 7