Lactate should be re-measured if the initial lactate was elevated. Lactic acid fermentation converts pyruvate to lactate by lactate dehydrogenase. The accumulating lactate causes lactic acidosis. Pyruvate can come from the breakdown of glucose, lactate, amino acids, or glycerol. During anaerobic glycolysis, NAD regenerates when pairs of hydrogen combine with pyruvate to form lactate. The accumulating pyruvate is converted to lactate by lactate dehydrogenase. The kidney in humans is capable of producing glucose from lactate, glycerol and glutamine. Reduction by lactate dehydrogenase produces lactate. Germanium can interfere with such enzymes as lactate and alcohol dehydrogenase. It is important to understand the difference between lactate threshold and lactic acid. Lactic acid, or lactate and H+ were created as a byproduct. As such, reduced systemic blood flow may result in increased serum lactate. A significant proportion of pyruvate is converted into lactate (usually 10&colon;1). They commonly contain benzoyl peroxide, chlorhexidine, povidone iodine, triclosan, ethyl lactate, or sulfur.