SHM Converge Scientific Abstract ePoster Gallery-Warburg Effect: Lactic Acidosis Due to Prostate Cancer

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This case report describes a 91-year-old man with encephalopathy, low bicarbonate, and persistent severe lactic acidosis. He was initially treated for presumed sepsis from a urinary tract infection with antibiotics and thiamine, and his mental status improved, but the lactate remained elevated despite normal hemodynamics, normal liver function, and no evidence of vitamin deficiency.<br /><br />A review of prior labs revealed an extremely high PSA level (481 ng/ml), and further evaluation showed extensive metastatic prostate cancer. Because the lactic acidosis persisted without signs of shock or hypoperfusion, the authors concluded this was type B lactic acidosis due to malignancy rather than type A lactic acidosis from sepsis.<br /><br />The report explains that type B lactic acidosis occurs without overt tissue hypoperfusion and can be seen in cancers, toxin exposure, liver disease, alcoholism, or mitochondrial dysfunction. In malignancy, one proposed mechanism is the Warburg effect: cancer cells preferentially use anaerobic glycolysis, producing excess lactate even when oxygen is available. In solid tumors, this complication is rare but often signals a heavy tumor burden and poor prognosis.<br /><br />The patient received degarelix, an androgen-deprivation therapy that rapidly lowers testosterone. The case emphasizes that persistent lactic acidosis should not automatically be attributed to sepsis and that clinicians should consider malignancy, especially when lactate remains high despite appropriate treatment and stable circulation.

Asset Subtitle

Jaeun Ahn

Meta Tag

Author List Jaeun Ahn, Phillip Ball, Sami Tahhan

Category Clinical Vignettes

Concept Lactic Acidosis

Concept Warburg Effect

Concept Type A Lactic Acidosis

Concept Type B Lactic Acidosis

Concept Cancer-Related Lactic Acidosis

Distinguished Non-Finalist

Presenter Organization Department of General Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA

Presenting Author Jaeun Ahn

Track Adult

Keywords

lactic acidosis

type B lactic acidosis

metastatic prostate cancer

encephalopathy

elevated PSA

Warburg effect

sepsis

androgen-deprivation therapy

degarelix

malignancy

Lactic Acidosis

Warburg Effect

Type A Lactic Acidosis

Type B Lactic Acidosis

Cancer-Related Lactic Acidosis