The blood lactate to pyruvate (L:P) ratio is used to distinguish between pyruvate dehydrogenase deficiency and other causes of congenital lactic acidosis. In conjunction with an elevated lactate, an L:P ratio greater than 30 suggests inherited disorders of the respiratory chain complex or tricarboxylic acid cycle disorders. In conjunction with an elevated lactate, an L:P ratio less than 25 suggests a defect in pyruvate metabolism. An artifactually high L:P ratio can be observed in acutely ill individuals. Abnormal concentrations of lactate, pyruvate, and the L:P ratio are not diagnostic for any single disorder and must be interpreted in the context of the individual's clinical presentation and other laboratory studies.
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