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Letter to the Editor. Hyperglycolysis as a common cause for elevated lactate in subarachnoid hemorrhage.

TO THE EDITOR: Engquist and colleagues1 reported that in patients with subarachnoid hemorrhage and delayed cerebral ischemia (DCI), the institution of “triple-H” therapy (hypervolemia, hemodilution, and hypertension [HHH]) increased cortical cerebral blood flow (cCBF) without improvement in the metabolic pattern as determined by cerebral microdialysis (Engquist H, Lewén A, Hillered L, et al. CBF changes and cerebral energy metabolism during hypervolemia, hemodilution, and hypertension therapy in patients with poor-grade subarachnoid hemorrhage [published online January 10, 2020]. J Neurosurg. doi:10.3171/2019.11.JNS192759). We suggest that hyperglycolysis may explain these findings. Lactate, an important shuttle for metabolic fuel in the body and brain, is produced through the reduction of pyruvate by lactate dehydrogenase (LDH):