Lactic acidosis as the initial manifestation of Acute Lymphoblastic Leukemia A case report.

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Karla Calderon
Robinson Ramirez
Liliana Compoverde


Introduction: Lactic acidosis is a rare manifestation of Acute Lymphoblastic Leukemia (ALL) in children; its pathogenesis is multifactorial and poorly understood. This association carries a fatal prognosis. Timely diagnosis and initiation of proper treatment for hematological neoplasia are the most critical factors in resolving this metabolic complication.

Clinical case: The case of a 5-year-old patient who was admitted to the emergency service with a month of generalized pallor, hyporexia, and ecchymosis is presented; 24 hours before, she had respiratory distress and acidotic respiration. On physical examination, cervical and inguinal adenopathies were found.

Diagnostic workshop: biometry was performed with white blood cells of 9.10 x 10/ul, neutrophils 41.6%, lymphocytes 44.6%, DHL 494 u/L, total bilirubin 0.33 mg/dl, potassium 2.55 mEq/L, Sodium 134 mEq/ L, calcium 11.8 mg/dl, TGP 16 U/L, Ac uric 4.7 mg/dl, Urea 33 mg/dl, Creatinine 0.99 mg/dl, ph 7.15, pCO2 18 mmHg, pO2 58.6 mmHg, HCO3 6.2 mmol/L, Base excess -20.4 mmol/L, Lactate 10 mmol/L. Normal kidney ultrasound. Bone marrow biopsy: pre-B stage acute lymphoblastic leukemia.

Evolution: Type B metabolic acidosis was treated with hydration and intravenous bicarbonate. She was referred for specific hemato-oncological treatment.

Conclusions: In the present case, the persistent metabolic acidosis, without evidence of tissue hypoperfusion, the differential diagnosis of hematological malignancies was considered.


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Calderon Salavarría, K., Ramírez Ruiz, R., & Campoverde, L. (2023). Lactic acidosis as the initial manifestation of Acute Lymphoblastic Leukemia: A case report. Revista Ecuatoriana De Pediatría, 24(2), 168-174.
Clinical Case
Author Biographies

Karla Calderon, Postgraduate Department of Pediatrics, Faculty of Medical Sciences, Universidad Católica Santiago de Guayaquil, - Ecuador.

 Postgraduate Physician at the Dr. Roberto Gilbert Elizalde Children's Hospital, Guayaquil-Ecuador

Robinson Ramirez, Hematology Service, Dr. Roberto Gilbert Elizalde Children's Hospital, Guayaquil, Ecuador.

Médico tratante del Servicio de Hematología infantil, Hospital de Niños Dr. Roberto Gilbert Elizalde.

Liliana Compoverde, Hematology Service, Dr. Roberto Gilbert Elizalde Children's Hospital, Guayquil Charity Board, Ecuador

Médico tratante del servicio de Hematología infantil,  Hospital de Niños Dr. Roberto Gilbert Elizalde, Junta de Beneficencia de Guayaquil. 


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