Type B lactic acidosis: a rare but life threatening hematologic emergency. A case illustration and brief review

Abstract

Major strides have been made in improving the treatment of medical emergencies associated with malignancies. Nonetheless, metabolic emergencies in cancer patients can often times be life-threatening. Type B lactic acidosis is a rare but potentially fatal paraneoplastic phenomenon that has been described in association with hematologic and solid malignancies and portends a poor prognosis if not rapidly recognized and treated. It is believed that this occurs as a result of cancer cells switching their glucose metabolism from an oxidative oxygen- dependent pathway towards a glycolytic phenotype, also known as the "Warburg effect". Though rare, it is important to consider this entity in the differential diagnosis of type B lactic acidosis since prompt identification and treatment may help improve outcomes in this otherwise fatal process. We present a case of type B lactic acidosis in a patient with chronic lymphocytic leukemia along with a brief review of the literature.

Keywords: Lactic acidosis; hematologic emergency; malignancy.

Figure 1

A. Oxydative pathway utilized by normal cell, largely dependent on oxygen concentration. B. Malignant phenotype with acquired glycolytic pathway, regardless of oxygen concentration. Gl-glucose, O2-RBC carrying oxygen, Mol-molecule, HIF-1- Hypoxia inducible factor 1.