Possible cannabinoid-induced lactic acidosis requiring emergent dialysis

Area of Science:

• Critical Care Medicine
• Toxicology
• Gastroenterology

Background:

• Lactic acidosis is a frequent and often fatal complication in intensive care units.
• Alcohol use disorder and cirrhosis are common comorbidities in critically ill patients.
• Cannabinoid use is increasingly prevalent, with potential for toxicity.

Observation:

• A 42-year-old male with alcohol use disorder and cirrhosis presented with acute shortness of breath.
• He was found to have profound lactic acidosis (25.6 mmol/L) and anion gap metabolic acidosis.
• The patient was hypertensive without signs of hypoperfusion.

Findings:

• The lactic acidosis was attributed to a rare manifestation of cannabinoid toxicity (Type B).
• Emergent dialysis was required to manage the severe metabolic derangement.
• No further marijuana use occurred post-discharge, and the patient recovered.

Implications:

• This case underscores the potential for severe, life-threatening lactic acidosis from cannabinoid toxicity.
• Clinicians should consider cannabinoid toxicity in patients with unexplained lactic acidosis, especially those with relevant comorbidities.
• Further research is needed to elucidate the mechanisms of cannabinoid-induced lactic acidosis.