Elevated Lactate Levels in a Non–Critically Ill Patient

Chen, Meng; Kim, Tiffany Y.; Pessegueiro, Antonio

doi:10.1001/jama.2014.14074

Cited by 10 publications

(8 citation statements)

References 5 publications

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“…Elevation of lactate in chronic liver diseases, such as cirrhosis, may be partially due to accelerated glycolysis in the splanchnic region [ 12 ]. However, the mechanism of hyperlactatemia in Mauriac syndrome and type B lactic acidosis is poorly understood [ 5 ]. A reduction in gluconeogenesis in the liver may raise lactate levels in the body.…”

Section: Discussionmentioning

confidence: 99%

“…Type B lactic acidosis is less commonly seen in critically ill patients and occurs without evidence of tissue hypoperfusion or shock [ 3 , 5 ]. Several etiologies of type B lactic acidosis have been described, such as drug metabolites, toxins, congenital enzyme deficiencies, grand Mal seizures, liver failure, hematologic malignancies, renal disease, ethanol intoxication, thiamine deficiency, and diabetes mellitus (DM) [ 1 – 3 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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A Rare Case of Persistent Lactic Acidosis in the ICU: Glycogenic Hepatopathy and Mauriac Syndrome

Deemer

Alvarez

2016

Case Reports in Critical Care

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Mauriac syndrome is a rare disorder that can present with the single feature of glycogenic hepatopathy in children and adults with poorly controlled diabetes mellitus. An often underrecognized finding of glycogenic hepatopathy is lactic acidosis and hyperlactatemia. Primary treatment of glycogenic hepatopathy is improved long-term blood glucose control. Resolution of symptoms and hepatomegaly will occur with improvement in hemoglobin A1C. We present here a case of a young adult female presenting to the intensive care unit with Mauriac syndrome. This case demonstrates exacerbation of lactic acidosis in a patient with glycogenic hepatopathy treated for diabetic ketoacidosis with high dose insulin and dextrose.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Rare Case of Persistent Lactic Acidosis in the ICU: Glycogenic Hepatopathy and Mauriac Syndrome

Deemer

Alvarez

2016

Case Reports in Critical Care

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“…As seen in our patient, elevation in lactic acid can occur in these patients [16]. e exact significance of this remains unknown [26]. However, some studies attribute this to reduced gluconeogenesis and lack of conversion of pyruvate to glucose [16].…”

Section: Discussionmentioning

confidence: 52%

Hepatocellular Glycogen Accumulation in the Setting of Poorly Controlled Type 1 Diabetes Mellitus: Case Report and Review of the Literature

Aluko

Enofe

Burch

et al. 2020

Case Reports in Hepatology

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Glycogenic hepatopathy (GH) is the accumulation of glycogen in the hepatocytes and represents a rare complication in patients with diabetes mellitus (DM), most commonly type 1 DM. We present a case of a 23-year-old woman with a medical history of poorly controlled type 1 DM and gastroesophageal reflux disease (GERD) who presented with progressively worsening right-sided abdominal pain. Diagnostic workup resulted in a liver biopsy with hepatocytes that stained heavily for glycogen with no evidence of fibrosis or steatohepatitis. A diagnosis of glycogenic hepatopathy was made, and an aggressive glucose control regimen was implemented leading to resolution of symptoms and improvement in AST, ALT, and ALP. In addition to presenting this rare case, we offer a review of literature and draw important distinctions between glycogenic hepatopathy and other differential diagnoses with the aim of assisting providers in the diagnostic workup and treatment of glycogenic hepatopathy.

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“…Elevated levels of glucose and insulin in prepubertal diabetic patients results in a state of hypercortisolism, which explains the pubertal and growth delays [ 3 , 7 ]. The exact mechanism for lactic acidosis reported in glycogenic hepatopathy is poorly understood [ 4 , 8 ]. It is felt that the reduction in gluconeogenesis in the liver and the resultant reduction in conversion of pyruvate to glucose may drive the anaerobic reaction of pyruvate to lactate.…”

Section: Discussionmentioning

confidence: 99%

Young Man with Hepatomegaly: A Case of Glycogenic Hepatopathy

Abboud

Abdulla

Za’abi

et al. 2018

Case Reports in Hepatology

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Glycogenic hepatopathy is a rare but potentially reversible condition characterized by hepatomegaly and elevated liver enzymes occurring in poorly controlled type 1 diabetes mellitus patients and often requires a liver biopsy to confirm the diagnosis. We present the case of a young man who was admitted with diabetic ketoacidosis in the setting of poorly controlled diabetes mellitus type 1 and was noted to have significantly elevated transaminases that continued to worsen despite appropriate treatment of the diabetic ketoacidosis. A liver biopsy confirmed the diagnosis of glycogenic hepatopathy and the patient improved with diabetes control. The aim of this report is to shed light on possible causes of significant elevation of liver enzymes in patients presenting with diabetic ketoacidosis. In addition, we would like to raise awareness about the diagnosis, management, and prognosis of glycogenic hepatopathy and how to differentiate it from other hepatic conditions that have a similar presentation.

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Elevated Lactate Levels in a Non–Critically Ill Patient

Cited by 10 publications

References 5 publications

A Rare Case of Persistent Lactic Acidosis in the ICU: Glycogenic Hepatopathy and Mauriac Syndrome

A Rare Case of Persistent Lactic Acidosis in the ICU: Glycogenic Hepatopathy and Mauriac Syndrome

Hepatocellular Glycogen Accumulation in the Setting of Poorly Controlled Type 1 Diabetes Mellitus: Case Report and Review of the Literature

Young Man with Hepatomegaly: A Case of Glycogenic Hepatopathy

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