Lactic acidosis and hypoglycemia: a metabolic complication of advanced gynecologic malignancy

Refractory lactic acidosis and hypoglycemia characterize a paraneoplastic syndrome observed in advanced gynecologic cancer, as illustrated by a patient with a large malignant mixed Mullerian tumor. Massive infusions of sodium bicarbonate and glucose failed to reverse her metabolic abnormalities, and the patient suffered a rapidly fatal course. The biochemical basis for this metabolic complication is reviewed, including how medical intervention can lead to iatrogenic exacerbation of the metabolic imbalance.