Smirnov Alexander, Semionov Michael, Ishay Shlomo Yaron, Zlotnik Alexander, Fraifeld Vadim E, Frank Dmitry
Department of Anesthesiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel.
Department of Cardiothoracic Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel.
Biomedicines. 2025 Feb 24;13(3):568. doi: 10.3390/biomedicines13030568.
Lactic acidosis is one of the most common causes of metabolic acidosis in hospitalized patients. It happens when lactic acid production exceeds lactic acid clearance. The elevation of lactate was commonly improved after the restoration of tissue perfusion. However, there are rare cases of severe lactate elevation (greater than 8 mmol/L) in the intraoperative period of thoracoscopic surgery. A poor prognosis with high morbidity and mortality characterizes these cases. A 72-year-old man was admitted to the Soroka University Medical Center for thoracoscopic robotic left upper lobe lobectomy due to squamous cell carcinoma. At the end of surgery (overall, 8.5 h), the lactate level reached 10.2 mmol/L with the development of severe lactic metabolic acidosis. Thiamine was successfully given to patients to stimulate lactate clearance towards the cycle of tricarboxylic acids via pyruvate. Though the pathogenesis of this state in our case is not fully clear, it may have been induced by chemotherapy and during tumor manipulation by a surgeon. The successful recovery of blood lactic levels after thiamine treatment is suggestive of thiamine deficiency as a possible cause of lactic acidosis in our patient. Although we do not have data on the plasma thiamine level, we suggest that its determination in the perioperative period would be beneficial for excluding a probable thiamine deficiency in the case of severe lactic acidosis.
乳酸性酸中毒是住院患者代谢性酸中毒最常见的原因之一。当乳酸生成超过乳酸清除时就会发生。组织灌注恢复后，乳酸水平通常会改善。然而，在胸腔镜手术的术中阶段，很少有严重乳酸升高（大于8 mmol/L）的情况。这些病例的特点是预后不良，发病率和死亡率高。一名72岁男性因鳞状细胞癌入住索罗卡大学医学中心接受胸腔镜机器人辅助左上叶肺叶切除术。手术结束时（总共8.5小时），乳酸水平达到10.2 mmol/L，并出现严重的乳酸性代谢性酸中毒。成功给予患者硫胺素，以通过丙酮酸刺激乳酸向三羧酸循环清除。虽然我们病例中这种状态的发病机制尚不完全清楚，但可能是由化疗和外科医生在肿瘤操作过程中诱发的。硫胺素治疗后血乳酸水平成功恢复，提示硫胺素缺乏可能是我们患者乳酸性酸中毒的一个原因。虽然我们没有血浆硫胺素水平的数据，但我们建议在围手术期测定其水平将有助于在严重乳酸性酸中毒的情况下排除可能的硫胺素缺乏。
