Druml W, Kleinberger G, Neumann E, Pichler M, Gassner A
Schweiz Med Wochenschr. 1981 Jan 31;111(5):146-50.
The clinical course and metabolic disturbances in three patients with acute leukemia and severe lactic acidosis (lactic acid concentrations 11.2, 17.0 and 21.0 mmol/l) are described. Circulatory failure could be ruled out as a possible cause of elevated lactic acid. Clinical findings included somnolence, hyperventilation and diffuse abdominal pain. In patients with malignant disease, a number of factors may contribute to elevated lactic acid levels. However, in our cases the excessive lactic acidosis was due to increased production of lactic acid by the leukemic cells, together with impaired hepatic metabolization. The diminished hepatic gluconeogenesis is also documented by a severe hypoglycemia in our patients. The essential step in treatment is early diagnosis of this syndrome and prompt initiation of cytotoxic medication.
本文描述了三名急性白血病合并严重乳酸性酸中毒（乳酸浓度分别为11.2、17.0和21.0 mmol/L）患者的临床病程及代谢紊乱情况。循环衰竭可排除为乳酸升高的可能原因。临床症状包括嗜睡、呼吸急促和弥漫性腹痛。在恶性疾病患者中，多种因素可能导致乳酸水平升高。然而，在我们的病例中，过度的乳酸性酸中毒是由于白血病细胞乳酸生成增加，同时肝脏代谢受损所致。我们的患者出现严重低血糖也证明了肝脏糖异生减少。治疗的关键步骤是早期诊断该综合征并及时开始使用细胞毒性药物。
