Energy metabolism in critically ill patients: lactate is a major oxidizable substrate.

The potential role of an energy defect in acute diseases is still in the centre of the pathophysiological understanding of such states and therefore of our attempts to limit or to reverse the possible deleterious consequences of such defect. In fact several recent experimental works have shown that instead of being a negative consequence, the lactate production and the related metabolic acidosis due to the stimulation of anaerobic ATP-production pathway is rather a protective adapted response.