Severe lactic acidosis in a patient with metastatic prostate cancer

Lactic acidosis (LA) due to malignancy was first reported in patients with acute leukemia. Since then, several malignancies have been reported to be associated with LA. The pathophysiology of cancer-related LA is multifactorial and still poorly understood. In general, chemotherapy is the only effective mean of correcting malignancy-related LA by cytoreduction of the tumor cells while at the same time decreasing malignant liver involvement leading to improved clearance of lactic acid. LA is rare in patients with malignancies and is usually associated with high mortality because of advanced disease process and high tumor burden. Increased awareness of this complication in certain malignancies is important because early initiation of chemotherapy may decrease LA and perhaps prolong survival. To our knowledge, this is the first case of otherwise unexplained severe LA in a patient with chemotherapy-refractory metastatic prostate cancer.