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Modern blood gas analysers are able to measure the blood lactate, a product of anaerobic metabolism and marker of the state of the microcirculation. In shock, elevated blood lactate levels can be used to predict mortality, and in septic shock raised lactate predicts the development of multiple organ failure more reliably than clinical observations. Failure of the lactate to fall with therapy is associated with higher mortality. Even haemodynamically stable patients with raised lactate levels, a condition referred to as compensated shock, are at increased risk of death. Lactate measurements >4 mmol/l can be taken as a marker of severe illness and used as a trigger to start resuscitation (see Chapter 7).