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Kidney Week

Abstract: FR-PO607

Severe Lactic Acidosis in a Patient with Advanced Hepatic Malignancy Due to Warburg Effect

Session Information

  • Trainee Case Reports - III
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Adiga, Avinash Govinda, NYU Langone Medical Center, New York, New York, United States
  • Rohit, Kumar, NYU Langone Medical Center, New York, New York, United States
Introduction

Lactic acidosis is one of the most common cause of metabolic acidosis in hospitalized pateints and is either due to overproduction or reduced metabolism of lactate. Impaired tissue oxygenation, either from decreased oxygen delivery or a defect in mitochondrial oxygen utilization usually causes increased lactate production. Causes of lactic acidosis can be divided into those associated with impaired tissue oxygenation as type-A and those without obvious systemic impairment in oxygenation as type B lactic acidosis. We report a case of severe type B lactic acidosis in a patient with extensive hepatic malignancy most likely from Warburg effect.

Case Description

62 years old male with history of hypertension, hypothyroidism and advanced hepatic metastatic gall bladder cancer admitted to the hospital due to failure to thrive. On examination BP was 128/80mmhg, HR 90/min, temperature was 95.3F. Patient was lethargic, abdomen was soft,distended and multiple bulky masses were appreciated in the right upper quadrant. Labs revealed Na:134, K: 4.2, Cl: 94, bicarb <10, BUN 53mg/dl, creatinine 3.0mg/dl, anion gap 24. ABG showed pH 7.11, pCO2:9.7, HCO3: 3, lactate >22 suggesting severe high anion gap metabolic acidosis due to lactate. He also had evidence of tumor lysis syndrome with LDH 2331, uric acid 14.1, phosphorus 9.1. CAT scan of abdomen showed infiltrative tumor replacing majority of both hepatic lobes with some sparing of superior right hepatic lobe.

Discussion

Metabolic modifcation is a typical hallmark of cancer cells, despite presence of adequate oxygen, tumor cells generate energy from aerobic glycolysis instead od mitochondrial oxidative phosphorylation.This phenomenon is defined as "Warburg effect", this leads to increased glycolysis, accumulation of ATP and lactate production by tumor cells. Warburg effect confers advantage to cell growth by providing carbon sources that are required for rapid cell proliferation and also by decreasing reactive oxygen species. This effect is more commonly seen in hematologic malignancies like lymphoma and leukemia, but can rarely be seen in solid malignancies. Our patient had features of tumor lysis and severe type B lactic acidosis, by excluding other causes of type B lactic acidosis it was attributed most likely due to Warburg effect. In addition impaired hepatic and renal clearance of lactate contributed to very high lactate levels.