Abstract: FR-PO264
Type B Lactic Acidosis Secondary to Metastatic Liver Cancer in the Setting of Normal Renal Function: A Case Report
Session Information
- Onconephrology: From AKI to CKD and Everything in Between
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Poyser, Tracy-Ann, Unity Health White County Medical Center, Searcy, Arkansas, United States
- Amakiri, Chidinma P., Unity Health White County Medical Center, Searcy, Arkansas, United States
- Pham, Steven, Unity Health White County Medical Center, Searcy, Arkansas, United States
Introduction
Lactic acidosis occurs when lactate levels are greater than 4 mmol/L. It is due to an overproduction of lactate or decreased metabolism. There are two types, Type A and Type B. Type B is more common in hematological conditions, such as multiple myeloma, leukemia, and lymphoma.
Case Description
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. Computed Tomography scan of the abdomen and pelvis showed extensive hepatic metastasis with marked hepatosplenomegaly and mild ascites. He had a lactic acid of 16.5 mmol/L, glucose of 52 mg/dl, and bicarbonate of 8 mEq. He received aggressive fluid resuscitation, IV antibiotics, and bicarbonate supplementation. However, his lactic acid worsened, requiring urgent dialysis. Despite dialysis, he showed no significant improvement, and was placed on hospice.
Discussion
Type B lactic acidosis can arise as a complication of solid and, more commonly, hematological malignancies, such as multiple myeloma, lymphoma, and leukemia. It is a rare complication that requires prompt diagnosis and treatment of the underlying condition. Treatment modalities, such as hemodialysis and chemotherapy, have been studied, but the prognosis remains poor. Our patient with type B lactic acidosis received hemodialysis, sodium bicarbonate, and glucose supplementation with marginal initial improvement, followed by worsening lactic acidosis. Due to the late stage of his cancer, chemotherapy was not beneficial. There is a paucity of information due to the rarity of studies on severe lactic acidosis. More studies are needed to better understand the pathogenesis of type B lactic acidosis secondary to hematological malignancies to improve patient outcomes.
Imaging showing extensive liver metastasis with significant hepatosplenomegaly and ascites.