<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_jccm-2019-0010_s_005_w2aab2b8b5b1b7b1aab1c16b1Aa"><h3>Background</h3><p>Lactic acidosis (LA) is a complication of diseases commonly seen in intensive care patients which carries an increased risk of mortality. It is classified by its pathophysiology; Type A results from tissue hypo-perfusion and hypoxia, and Type B results from abnormal metabolic activity in the absence of hypoxia. Reports of the co-occurrence of both types have been rarely reported in the literature relating to intensive care patients. This case report describes the challenging management of a patient diagnosed with both Type A and Type B LA.</p></sec><sec id="j_jccm-2019-0010_s_006_w2aab2b8b5b1b7b1aab1c16b2Aa"><h3>Case presentation</h3><p>A 55-year-old female with newly diagnosed diffuse large B-cell lymphoma (DLBCL) developed hospital-acquired pneumonia, respiratory failure, shock and intra-abdominal septicaemia from a bowel perforation. Blood gases revealed a mixed picture lactic acidosis. Correction of septic shock, respiratory failure and surgical repair caused initial improvement to the lactic acidosis, but this gradually worsened in the intensive care unit. Only upon starting chemotherapy and renal replacement therapy was full resolution of the lactic acidosis achieved. The patient was discharged but succumbed to her DLBCL several months later.</p></sec><sec id="j_jccm-2019-0010_s_007_w2aab2b8b5b1b7b1aab1c16b3Aa"><h3>Conclusion</h3><p>Type A and Type B LA can co-occur, making management difficult. A systematic approach can help diagnose any underlying pathology and aid in early management.</p></sec></abstract>

BackgroundLactic acidosis (LA) is a complication of diseases commonly seen in intensive care patients which carries an increased risk of mortality. It is classified by its pathophysiology; Type A results from tissue hypo-perfusion and hypoxia, and Type B results from abnormal metabolic activity in the absence of hypoxia. Reports of the co-occurrence of both types have been rarely reported in the literature relating to intensive care patients. This case report describes the challenging management of a patient diagnosed with both Type A and Type B LA.Case presentationA 55-year-old female with newly diagnosed diffuse large B-cell lymphoma (DLBCL) developed hospital-acquired pneumonia, respiratory failure, shock and intra-abdominal septicaemia from a bowel perforation. Blood gases revealed a mixed picture lactic acidosis. Correction of septic shock, respiratory failure and surgical repair caused initial improvement to the lactic acidosis, but this gradually worsened in the intensive care unit. Only upon starting chemotherapy and renal replacement therapy was full resolution of the lactic acidosis achieved. The patient was discharged but succumbed to her DLBCL several months later.ConclusionType A and Type B LA can co-occur, making management difficult. A systematic approach can help diagnose any underlying pathology and aid in early management.

Refractory Lactic Acidosis and an Approach to Its Management - A Case Report

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

{"article-title":"Refractory Lactic Acidosis and an Approach to Its Management - A Case Report"}

BackgroundLactic acidosis (LA) is a complication of diseases commonly seen in intensive care patients which carries an increased risk of mortality. It is...

Refractory Lactic Acidosis and an Approach to Its Management - A Case Report

Article Category: Case report

Published Online: May 13, 2019

Page range: 60 - 65

Received: Mar 12, 2019

Accepted: Apr 24, 2019

DOI: https://doi.org/10.2478/jccm-2019-0010

Keywords
lactic acidosis, hyperlactatemia, critical care, intensive care

© 2019 Yingke He, John Ong, Sharon Ong, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Refractory Lactic Acidosis and an Approach to Its Management - A Case Report

Article Category: Case report

Published Online: May 13, 2019

Page range: 60 - 65

Received: Mar 12, 2019

Accepted: Apr 24, 2019

DOI: https://doi.org/10.2478/jccm-2019-0010

Keywordslactic acidosis, hyperlactatemia, critical care, intensive care

© 2019 Yingke He, John Ong, Sharon Ong, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Keywords
lactic acidosis, hyperlactatemia, critical care, intensive care