Over the last half-decade, there has been a distinct shift in the approach to lactate elevation. The long-held belief that elevated serum lactate requires tissue or cellular hypoxia has fallen away. Indeed, in sepsis, tissues bathed in oxygen and with fully functional mitochondria can produce large amounts of lactate. Part of the confusion stems from the terms anaerobic and aerobic; anaerobic chemistry simply means that oxygen is not required to proceed, but this doesn’t necessitate oxygen’s absence. Glycolysis [the breakdown of glucose to pyruvic acid] is always anaerobic; anaerobic glycolysis is occurring within you right now – as you read this. Glycolysis can proceed without oxygen, it was occurring within prokaryotes long before the eukaryotic revolution, the oxygen-containing atmosphere and mitochrondrial respiration.

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