Abstract | INTRODUCTION: 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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Authors | Andrew John Gardner, John Griffiths |
Journal | Journal of medical case reports
(J Med Case Rep)
Vol. 9
Pg. 16
(Jan 14 2015)
ISSN: 1752-1947 [Electronic] England |
PMID | 25588681
(Publication Type: Case Reports, Journal Article, Review)
|
Chemical References |
- Antibiotics, Antineoplastic
- Lactic Acid
- Doxorubicin
|
Topics |
- Acidosis, Lactic
(diagnosis, physiopathology, therapy)
- Aged
- Antibiotics, Antineoplastic
(therapeutic use)
- Doxorubicin
(therapeutic use)
- Fatal Outcome
- Hematoma, Subdural, Acute
(physiopathology, surgery)
- Humans
- Lactic Acid
(blood)
- Leukemia, Myelomonocytic, Chronic
(complications, physiopathology, therapy)
- Male
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