Dobish Mark A, Wyler David A, Farrell Christopher J, Dhami Hermandeep S, Romo Victor M, Choi Daniel D, Reed Travis, Mahla Michael E
Anesthesiology Resident, Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Assistant Professor of Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Case Rep Crit Care. 2018 Sep 27;2018:8795036. doi: 10.1155/2018/8795036. eCollection 2018.
This report displays a rare presentation of lactic acidosis in the setting of status epilepticus (SE). The differential diagnosis of lactic acidosis is broad and typically originates from states of shock; however, this report highlights an alternative and rare etiology, SE, due to chronic skull base erosion from temporomandibular joint (TMJ) disease. Lactic acidosis is defined by a pH below 7.35 in the setting of lactate values greater than 5 mmol/L. Two broad classifications of lactic acidosis exist: a type A lactic acidosis which stems from global or localized tissue hypoxia or a type B lactic acidosis which occurs once mitochondrial oxidative capacity is unable to match glucose metabolism. SE is an example of a type A lactic acidosis in which oxygen delivery is unable to meet increased cellular energy requirements. This report is consistent with a prior case series that consists of five patients experiencing generalized tonic-clonic (GTC) seizures and lactic acidosis. These patients presented with a pH range of 6.8-7.41 and lactate range of 3.8-22.4 mmol/L. Although severe lactic acidosis following GTC has been described, this is the first report in the literature of chronic skull base erosion from TMJ disease causing SE.
本报告展示了癫痫持续状态（SE）情况下乳酸酸中毒的一种罕见表现。乳酸酸中毒的鉴别诊断范围广泛，通常源于休克状态；然而，本报告强调了一种罕见的病因——颞下颌关节（TMJ）疾病导致慢性颅底侵蚀引起的SE。乳酸酸中毒定义为在乳酸值大于5 mmol/L的情况下pH低于7.35。乳酸酸中毒存在两种广泛分类：A型乳酸酸中毒源于全身性或局部性组织缺氧，B型乳酸酸中毒则在线粒体氧化能力无法与葡萄糖代谢相匹配时发生。SE是A型乳酸酸中毒的一个例子，其中氧输送无法满足增加的细胞能量需求。本报告与之前一个包含5例全身性强直阵挛（GTC）发作和乳酸酸中毒患者的病例系列一致。这些患者的pH范围为6.8 - 7.41，乳酸范围为3.8 - 22.4 mmol/L。虽然已有关于GTC后严重乳酸酸中毒的描述，但这是文献中首例关于TMJ疾病导致慢性颅底侵蚀引起SE的报告。
