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A case of type B lactic acidosis as a complication of chronic myelomonocytic leukaemia: a case report and review of the literature

INTRODUCTION: Type B lactic acidosis represents a rare and often lethal complication of haematological malignancy. Here, we present a patient who developed a type B lactic acidosis presumably due to a concurrent chronic myelomonocytic leukaemia. Upon swift initiation of cytoreductive chemotherapy (d...

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Autores principales: Gardner, Andrew John, Griffiths, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325955/
https://www.ncbi.nlm.nih.gov/pubmed/25588681
http://dx.doi.org/10.1186/1752-1947-9-16
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author Gardner, Andrew John
Griffiths, John
author_facet Gardner, Andrew John
Griffiths, John
author_sort Gardner, Andrew John
collection PubMed
description INTRODUCTION: Type B lactic acidosis represents a rare and often lethal complication of haematological malignancy. Here, we present a patient who developed a type B lactic acidosis presumably due to a concurrent chronic myelomonocytic leukaemia. Upon swift initiation of cytoreductive chemotherapy (doxorubicin), the lactic acidosis was rapidly brought under control. This case adds to the literature reporting other haematological malignancies that can cause a type B lactic acidosis and its successful treatment. CASE PRESENTATION: We report the case of a 77-year-old Caucasian man brought to our Accident and Emergency department following an unwitnessed collapse; he was found surrounded by coffee-ground vomit. Although haemodynamically stable on admission, he rapidly deteriorated as his lactic acid rose. An initial arterial blood gas revealed a pH of 7.27 and lactate of 18mmol/L (peaking at 21mmol/L). CONCLUSIONS: A high degree of clinical suspicion for haematological malignancy should be held when presented with a patient with lactic acidosis in clinical practice, even without evidence of poor oxygenation or another cause. Treatment with emergency chemotherapy, in lieu of a definitive diagnosis, was rapidly successful at lowering lactate levels within 8 hours. This may suggest a causal and perhaps direct relationship between lactic acid production and the presence of leukemic cells. Veno-venous haemofiltration had no apparent effect on reducing the lactic acidosis and therefore its benefit is questioned in this setting, especially at the cost of delaying chemotherapy. In the face of a life-threatening lactic acidosis, pragmatic clinical judgement alone may justify the rapid initiation of chemotherapy.
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spelling pubmed-43259552015-02-13 A case of type B lactic acidosis as a complication of chronic myelomonocytic leukaemia: a case report and review of the literature Gardner, Andrew John Griffiths, John J Med Case Rep Case Report INTRODUCTION: Type B lactic acidosis represents a rare and often lethal complication of haematological malignancy. Here, we present a patient who developed a type B lactic acidosis presumably due to a concurrent chronic myelomonocytic leukaemia. Upon swift initiation of cytoreductive chemotherapy (doxorubicin), the lactic acidosis was rapidly brought under control. This case adds to the literature reporting other haematological malignancies that can cause a type B lactic acidosis and its successful treatment. CASE PRESENTATION: We report the case of a 77-year-old Caucasian man brought to our Accident and Emergency department following an unwitnessed collapse; he was found surrounded by coffee-ground vomit. Although haemodynamically stable on admission, he rapidly deteriorated as his lactic acid rose. An initial arterial blood gas revealed a pH of 7.27 and lactate of 18mmol/L (peaking at 21mmol/L). CONCLUSIONS: A high degree of clinical suspicion for haematological malignancy should be held when presented with a patient with lactic acidosis in clinical practice, even without evidence of poor oxygenation or another cause. Treatment with emergency chemotherapy, in lieu of a definitive diagnosis, was rapidly successful at lowering lactate levels within 8 hours. This may suggest a causal and perhaps direct relationship between lactic acid production and the presence of leukemic cells. Veno-venous haemofiltration had no apparent effect on reducing the lactic acidosis and therefore its benefit is questioned in this setting, especially at the cost of delaying chemotherapy. In the face of a life-threatening lactic acidosis, pragmatic clinical judgement alone may justify the rapid initiation of chemotherapy. BioMed Central 2015-01-14 /pmc/articles/PMC4325955/ /pubmed/25588681 http://dx.doi.org/10.1186/1752-1947-9-16 Text en © Gardner and Griffiths; licensee BioMed Central. 2015 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Gardner, Andrew John
Griffiths, John
A case of type B lactic acidosis as a complication of chronic myelomonocytic leukaemia: a case report and review of the literature
title A case of type B lactic acidosis as a complication of chronic myelomonocytic leukaemia: a case report and review of the literature
title_full A case of type B lactic acidosis as a complication of chronic myelomonocytic leukaemia: a case report and review of the literature
title_fullStr A case of type B lactic acidosis as a complication of chronic myelomonocytic leukaemia: a case report and review of the literature
title_full_unstemmed A case of type B lactic acidosis as a complication of chronic myelomonocytic leukaemia: a case report and review of the literature
title_short A case of type B lactic acidosis as a complication of chronic myelomonocytic leukaemia: a case report and review of the literature
title_sort case of type b lactic acidosis as a complication of chronic myelomonocytic leukaemia: a case report and review of the literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325955/
https://www.ncbi.nlm.nih.gov/pubmed/25588681
http://dx.doi.org/10.1186/1752-1947-9-16
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