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Kidney Week

Abstract: PO1170

Diffuse Large B Cell Lymphoma and Synchronous Colon Adenocarcinoma Presenting with Type B Lactic Acidosis Secondary to the Warburg Effect in a Hispanic Man

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

  • 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Varela, Daniel, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, United States
  • Pozo Garcia, Leonardo, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, United States
  • Hernandez, Daniela, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, United States
  • Alsabbagh, Mourad, DHR Health, Edinburg, Texas, United States
  • Manllo, John, South Texas Kidney Specialists, McAllen, Texas, United States
  • Trevino Manllo, Sergio A., South Texas Kidney Specialists, McAllen, Texas, United States
Introduction

Lactic acidosis is a major metabolic dysregulation characterized by hyperlactatemia and acidemia that is commonly associated with tissue hypoperfusion. In very rare circumstances, hematological malignancies have been associated with a paraneoplastic syndrome characterized by the modification of the metabolism of cancerous cells from aerobic to anaerobic glycolysis.

Case Description

A 61-year-old male presented to the hospital due to generalized body weakness. He was recently admitted to the hospital due to left knee pain; at that time incision, drainage, and tissue sample were done. The patient was discharged to home with wound care and antibiotics.
On presentation, patient was found to be tachypneic, hypotensive with Kussmaul breathing. A warm erythematous lesion was seen on left lower extremity. Laboratory results showed WBC 20200/mm3, Hemoglobin 10 g/dL, Platelets 340 /mm3, creatinine 7.9 mg/dL, Bicarbonate 5 mmol/L, Lactate 6.21 mg/dL, and Ferritin 326 ng/dL, blood cultures positive for Enterobacter. Broad-spectrum antibiotics were administered. Nephrology consulted and dialysis started emergently. The pathology report showed Diffuse Large B-Cell Lymphoma.
During the hospital stay, patient acidosis was persistent despite adequate renal replacement therapy and resolution of the septic process. ABG was done showing serum pH of 7.2, Bicarbonate 9 mmol/L, Lactic acid 17.5 mg/dL. Bowel ischemia was ruled out with CT angiogram however imaging showed neoplastic infiltration of peritoneal abdominal structures associated with multiple small nodules. Colonoscopy demonstrated synchronous colon adenocarcinoma. The decision was made to treat the patient with chemotherapy. One week after chemotherapy lactic acid trended down to 1.1 mg/dL. The metabolic acidosis and renal function improved and RRT was stopped.

Discussion

Usually, lactic acidosis is a sign of hypoperfusion and septic shock. In this case, the source of lactic acidosis was not hypoperfusion but rather a rare paraneoplastic syndrome that leads to anaerobic metabolism of malignant cells, known as the Warburg effect. This condition can be fatal. Prompt initiation of chemotherapy is recommended