Chronic lactic acidosis in a patient with cancer: Therapy and metabolic consequences

Fields, Anthony; Wolman, Stephen L.; Ml, Halperin

doi:10.1002/1097-0142(19810415)47:8<2026::aid-cncr2820470821>3.0.co;2-g

Cited by 45 publications

(11 citation statements)

References 18 publications

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“…In 102 patients with phenformin-lactic acidosis, infusion of a mean of 527 meq of NaHCO3 normalized arterial pH in 66% of patients (28). However, infusion of 500-1,200 meq/d of NaHCO3 had no effect on arterial pH in five patients with other forms of lactic acidosis (2,29,30). Our dogs were potentially different from patients with lactic acidosis in several respects.…”

Section: Discussionsupporting

confidence: 68%

“…It may be that if arterial pH had been normalized, the effects on lactic acidosis might have been different. In reviewing the literature, one sees that it has been possible to normalize arterial pH with NaHCO3 in some individuals with lactic acidosis but not in others (2,(27)(28)(29)(30). In 102 patients with phenformin-lactic acidosis, infusion of a mean of 527 meq of NaHCO3 normalized arterial pH in 66% of patients (28).…”

Section: Discussionmentioning

confidence: 74%

“…In addition, infusion of bicarbonate resulted in production by the gut of an almost stoichiometric quantity of lactic acid (6). Thus, in this animal model, as well as in several reported cases, effective alkalinization was not possible (2,27,29,30). The most important factor in determining survival in patients with lactic acidosis may well be the presence of shock.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Lactic Acidosis with Dichloroacetate in Dogs

Park¹,

Arieff²,

Leach³

et al. 1982

J. Clin. Invest.

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A B S T R A C T Lactic acidosis is a clinical condition due to accumulation of H+ ions from lactic acid, characterized by blood lactate levels >5 mM and arterial pH <7.25. In addition to supportive care, treatment usually consists of intravenous NaHCO3, with a resultant mortality >60%. Dichloroacetate (DCA) is a compound that lowers blood lactate levels under various conditions in both man and laboratory animals. It acts to increase pyruvate oxidation by activation of pyruvate dehydrogenIse. We evaluated the effects of DCA in the treatment of two different models of type B experimental lactic acidosis in diabetic dogs: hepatectomy-lactic acidosis and phenformin-lactic acidosis. The metabolic and systemic effects examined included arterial blood pH and levels of bicarbonate and lactate; the intracellular pH (pHi) in liver and skeletal muscle; cardiac index, arterial blood pressure and liver blood flow; liver lactate uptake and extrahepatic splanchnic (gut) lactate production; and mortality. Effects of DCA were compared with those of either NaCl or NaHCO3. The infusion of DCA and NaHCO3, delivered equal amounts of volume and sodium, although the quantity of NaHCO3 infused (2.5 meq/kg per h) was insufficient to normalize arterial pH.In phenformin-lactic acidosis, DCA-treated animals had a mortality of 22%, vs. 89% in those treated with NaHCO3. DCA therapy increased arterial pH and bicarbonate, liver pHi and cardiac index, with increased This work was presented in part at

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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Treatment of Lactic Acidosis with Dichloroacetate in Dogs

Park¹,

Arieff²,

Leach³

et al. 1982

J. Clin. Invest.

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“…51 Alkalinization also has been shown to potentiate lactate production in patients with malignancy-induced chronic LA. 52,53 In our cases, as well in most of the other reported cases, alkalinization was ineffective. However, this treatment may be necessary to prevent the adverse cardiovascular effects of elevated lactate concentration, especially in the presence of acidosis.…”

Section: Discussionmentioning

confidence: 99%

Lactic acidosis: A metabolic complication of hematologic malignancies

Sillos

Shenep

Burghen

et al. 2001

Cancer

166

175

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“…High doses of sodium bicarbonate have failed to improve lactic acidosis induced by malignancy while the acidosis subsides after chemotherapy [16–19]. Other causes of lactic acidosis including sepsis and phenphormin-induced lactic acidosis are also resistant to bicarbonate therapy [20, 36].…”

Section: Sodium Bicarbonate Therapy In Metabolic Acidosismentioning

confidence: 99%

Sodium Bicarbonate Therapy in Patients with Metabolic Acidosis

Adeva‐Andany¹,

Fernández‐Fernández²,

Mouriño-Bayolo³

et al. 2014

The Scientific World Journal

108

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Metabolic acidosis occurs when a relative accumulation of plasma anions in excess of cations reduces plasma pH. Replacement of sodium bicarbonate to patients with sodium bicarbonate loss due to diarrhea or renal proximal tubular acidosis is useful, but there is no definite evidence that sodium bicarbonate administration to patients with acute metabolic acidosis, including diabetic ketoacidosis, lactic acidosis, septic shock, intraoperative metabolic acidosis, or cardiac arrest, is beneficial regarding clinical outcomes or mortality rate. Patients with advanced chronic kidney disease usually show metabolic acidosis due to increased unmeasured anions and hyperchloremia. It has been suggested that metabolic acidosis might have a negative impact on progression of kidney dysfunction and that sodium bicarbonate administration might attenuate this effect, but further evaluation is required to validate such a renoprotective strategy. Sodium bicarbonate is the predominant buffer used in dialysis fluids and patients on maintenance dialysis are subjected to a load of sodium bicarbonate during the sessions, suffering a transient metabolic alkalosis of variable severity. Side effects associated with sodium bicarbonate therapy include hypercapnia, hypokalemia, ionized hypocalcemia, and QTc interval prolongation. The potential impact of regular sodium bicarbonate therapy on worsening vascular calcifications in patients with chronic kidney disease has been insufficiently investigated.

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Chronic lactic acidosis in a patient with cancer: Therapy and metabolic consequences

Cited by 45 publications

References 18 publications

Treatment of Lactic Acidosis with Dichloroacetate in Dogs

Treatment of Lactic Acidosis with Dichloroacetate in Dogs

Lactic acidosis: A metabolic complication of hematologic malignancies

Sodium Bicarbonate Therapy in Patients with Metabolic Acidosis

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