Abstract Introduction Severe lactic acidosis may occur in hematologic malignancies, and its presence is associated with a high mortality rate. The etiology may be due to the Warburg effect, thiamine deficiency, and renal or hepatic dysfunction. We present a case of a female who was admitted a second time with severe lactic acidosis from B-cell acute lymphoblastic leukemia (B-ALL). Case Presentation A 42-year-old female, with a history of relapsed/refractory B-ALL, had presented to the hospital for chemotherapy. She had a recent admission with severe lactic acidosis suspected to be due to her malignancy which improved with sodium bicarbonate, dexamethasone, and chemotherapy. During this admission, she had severe lactic acidosis suspected to be due to malignancy again. She was tachypneic but denied any shortness of breath. Her blood gas showed pH of 7.13 and a pCO2 of 27 mm Hg. Her bicarbonate level was 11 mmol/L and lactic acid level was 11 mmol/L. She was started on dexamethasone, bicarbonate infusion, and transferred to the ICU with plans for chemotherapy initiation. However, despite the initiation of similar therapy again, she continued to decline. Her repeat values were a pH of 7, bicarbonate of 6 mmol/L, and lactic acid of 17 mmol/L. She was placed on renal replacement therapy, started on thiamine and antibiotic therapy, and placed on mechanical ventilation due to worsening mental and respiratory status. She then became hemodynamically unstable requiring multiple vasopressors. Despite the interventions, she continued to deteriorate and eventually passed. Discussion Lactic acidosis from malignancies is a rare phenomenon that can have life-threatening consequences as mortality appears to be high. One hypothesis for lactic acidosis is the Warburg effect, which is a switch to anaerobic glycolysis resulting in the production of lactic acid. Other theories include renal or hepatic dysfunction which leads to ineffective lactate clearance. There are reports of patients with malignancy-associated lactic acidosis being treated with chemotherapy. In the case of our patient, her first presentation with severe lactic acidosis had a positive outcome that ended with discharge home, but her second presentation, unfortunately, did not have a similar outcome. Conclusion Prognosis for patients who develop malignancy-related lactic acidosis appears to be poor. Our case highlights that lactic acidosis from malignancy could have a favorable response to therapy but, ultimately, if the malignancy remains, patients may return with a similar clinical presentation, and therapy may not be favorable again. This abstract is funded by: None
Chen et al. (Fri,) studied this question.