Sustained low-efficiency dialysis as a treatment modality in a patient with lymphoma-associated lactic acidosis.

Lactic acidosis is a potentially life-threatening metabolic disorder, initiated by an imbalance between lactic acid production and utilization. The only effective treatment is reversal of the cause of the disordered lactic acid metabolism [1]. Intravenous bicarbonate (HCO3 ) administration is often used as an interim treatment to attempt to ameliorate the effects of the acidosis, particularly ventilatory fatigue and haemodynamic instability [2,3], even though this treatment has not been shown to improve either haemodynamic stability or overall survival [4]. The ability of bicarbonate to correct the metabolic acidosis is limited by complications from rapid administration of hypertonic fluid and by alkali-induced stimulation of lactic acid production [1]. Lactic acidosis associated with haematological malignancies is a rare condition, where the latter effect is best illustrated [5]. To avoid the problem of hypertonic fluid administration, continuous renal replacement therapy has been used to try to correct metformin-associated lactic acidosis [6]. In this report, we describe a patient with undiagnosed B-cell lymphoma who presented with severe lactic acidosis requiring intubation and ventilatory support. The acidosis was corrected by delivering large amounts of alkali, using sustained low efficiency dialysis (SLED), despite evidence of continuous or even increased lactic acid production. This treatment stabilized the patient until chemotherapy was initiated and halted the abnormal lactic acid metabolism. Measurement of the preand post-dialysis membrane serum lactate concentration allowed us to estimate the rate of lactate removal by SLED in this case.