Lactic Acidosis in Patient with Neoplastic Disease

 

Neoplastic diseases associated with lactic acidosis:

(1) leukemia

(2) malignant non-Hodgkin's lymphoma

(3) Hodgkin's lymphoma

(4) small cell undifferentiated or other lung cancers

(5) other solid tumors

 

Clinical findings:

(1) tachypnea

(2) tachycardia

(3) abdominal pain

(4) hepatomegaly (with liver metastases)

(5) unexplained clinical deterioration

 

Laboratory findings:

(1) metabolic acidosis with pH < 7.3

(2) lactic acid > 5 mmol/L

 

Risk factors:

(1) higher tumor burden (which may be related with increased glycolysis)

(2) extensive liver metastasis and/or severe hepatic dysfunction

(3) impaired renal clearance of lactate

 

Diagnosis as being paraneoplastic requires exclusion of other causes of lactic acidosis.

 

The mainstay of therapy is chemotherapy to reduce the tumor burden.

 

Exogenous buffer may need to be given in severe acidosis to temporarily stabilize the patient while chemotherapy reduces the tumor burden. Bicarbonate has been associated with increased production of lactic acid.