Type B Lactic Acidosis Secondary to Metastatic Liver Cancer in the Setting of Normal Renal Function: A Case Report and Literature Review

Abstract

Lactic acidosis occurs from an overproduction of lactate or decreased metabolism. It is common in critically ill patients, especially those with hematological conditions such as multiple myeloma, leukemia, and lymphoma. There are two types of lactic acidosis, Type A and Type B, with Type B presenting more commonly in hematological conditions that require prompt diagnosis and treatment of the underlying condition. We present a case of a 43-year-old male with Type B lactic acidosis secondary to stage IV colon cancer with metastasis to the liver. Initial laboratory work was significant for lactic acid of 16.52 mmol/L. Arterial blood gas (ABG) showed pH 7.26, pCO₂ 21 mmHg, pO₂ 111 mmHg, and HCO₃ 9 mEq/L, revealing an anion gap and metabolic acidosis with compensatory respiratory alkalosis. Initially, the patient was treated with aggressive fluid management, IV antibiotics, and sodium bicarbonate; however, his lactic acid continued to rise. The recommendation was made for urgent dialysis. Despite treatments, the prognosis is poor.

Keywords: continuous renal replacement therapy (crrt); lactic acidosis; malignancy; metabolic acidosis; metastatic liver cancer; oncological emergency.

Figure 1. Chest X-ray showing elevated right hemidiaphragm secondary to liver burden. Atelectasis/scarring of the right lung base is noted by the blue arrow.

Figure 2. CT abdomen/pelvis showing extensive liver metastasis with significant hepatomegaly noted by the blue arrows. Liver measured greater than 30 cm in length. Splenomegaly and ascites were also noted in the study.