A Case of Severe Type B Lactic Acidosis in a Patient with Acute Lymphoblastic Leukemia

The development of type B lactic acidosis related to hematologic malignancies is a rare phenomenon. The exact mechanism is not known but can result in death if not recognized and corrected. The mainstay of therapy remains systemic cancer-directed therapy to treat the underlying disease although intravenous bicarbonate and renal replacement therapy have been employed at times for acute treatment of severe lactic acidosis as a bridge until chemotherapy can be initiated. However, these therapies do not appear to have a long-term effect. In this care report, we present a 75-year-old-male with acute lymphoblastic leukemia who was admitted to the hematology/oncology service after routine labs drawn in clinic revealed a lactate dehydrogenase (LDH) level of 4554 U/L thought to be due to severe type B lactic acidosis portending poor prognosis. Prompt diagnosis and treatment of this rare complication of hematologic malignancies is critical in trying to prevent poor outcomes.