Multiple Myeloma Associated with Lactic Acidosis

Abstract

Type B lactic acidosis is rare among patients with malignant diseases. To date only one case report has documented lactic acidosis occurring in a patient with multiple myeloma (MM). Our patient, a 55-year-old black man, was diagnosed with stage IIIA immunoglobulin G-kappa (IgG-kappa) MM in September 1995. He was found to have severe lactic acidosis at the time of second relapse. During the terminal phase of his disease, he required multiple hospitalizations for management of lactic acidosis and other complications of his MM. No other cause of his elevated lactate levels was identified. Although type B lactic acidosis may more commonly occur in patients with leukemia or lymphoma, it may rarely present in patients with rapidly progressive and refractory MM.

Lactic Acidosis: From Sour Milk to Septic Shock

“…There is evidence for altered carbohydrate metabolism in some cancer cells with increased glycolytic activity [56]. Interestingly, we and others have noted the improvement in lactate levels with disease remission [55]. Finally, Type B lactic acidosis may be caused by decreased clearance of lactate from extensive liver involvement by tumor [57].…”

Elevation in serum lactate at the time of Febrile Neutropenia (FN) in hemodynamically-stable patients with Hematologic Malignancies (HM) is associated with the development of septic shock within 48 hours

“…There are many reports in the literature of patients with HM who have lactic acidemia independent of systemic oxygenation and organ perfusion, due to tumor-related lactic acid production and the prevalence of hyperlactatemia in patients with HM is unknown. [34][35][36][37][38][39][40][41] Thus, generalizing the utility of serum lactate measurements without prospective validation to a patient population that may experience higher basal serum lactate levels may subject these patients to inappropriate ICU transfer and aggressive resuscitation strategies. Our study addressed this clinical equipoise and extends the validity of current critical care guidelines to HM patients by providing evidence that lactic acid A power calculation suggested that matching controls to cases in a 4:1 ratio would achieve 80% power (α = 0.05) to detect an association (OR ≥ 2.5) between elevated serum lactate levels and the development of septic shock within 48 h of FN.…”

Hypoglycemia and Hyperlactatemia Associated with Lymphoma in an Angus Cow

“…Concurrent hypoglycemia and hyperlactatemia secondary to enzootic bovine lymphosarcoma in a cow is unusual. Lactic acidosis is a rare and highly fatal complication of hematopoeitic neoplasms in human patients with a 7% survival rate with chemotherapy 2–7 . The precise mechanism is unknown but defective glycolytic processes, liver failure, and renal failure all have been implicated 3 .…”

“…There are sporadic reports of hypoglycemia and lactic acidosis occurring in people secondary to malignant neoplasms 2–7 . Forty‐three of 53 patients with lactic acidosis secondary to leukemia and lymphoma had hepatic involvement and 20 of 53 had hypoglycemia 7 .…”

“…Lactic acidosis is a rare and highly fatal complication of hematopoeitic neoplasms in human patients with a 7% survival rate with chemotherapy. [2][3][4][5][6][7] The precise mechanism is unknown but defective glycolytic processes, liver failure, and renal failure all have been implicated. 3 Some neoplastic cells overexpress hexokinase, a rate-limiting glycolytic enzyme with a high affinity for glucose, which may increase uptake and utilization of glucose resulting in overproduction of lactate despite adequate tissue oxygenation.…”