Successful Treatment of Tumor-Induced Lactic Acidosis With Tris-Hydroxymethyl Aminomethane (THAM)

Tumor cells have the ability to alter their metabolome to favor aerobic glycolysis. Known as the Warburg effect, this process ends with the production of lactate. Overt tumor-mediated lactic acidosis is associated with poor prognosis, and treatment options to reverse acidemia are limited. A man in his early 70s with a recently found undifferentiated pelvic mass presented with progressive dyspnea. He was diagnosed with tumor-mediated lactic acidosis. He was treated with repeated doses of tris-hydroxymethyl aminomethane buffer, which rapidly corrected his acidemia, sparing the need for invasive ventilation. A computed tomography--guided biopsy of his inguinal mass revealed CD20/L26-positive diffuse large B-cell lymphoma. He was treated with methylprednisolone and chemotherapy without recurrence of lactic acidosis. Acidemia impairs the hepatic uptake of lactate, and clearance of lactate through inhibition of lactate dehydrogenase and the Krebs cycle. This propagates further lactic acidosis. The therapeutic use of isotonic bicarbonate solution is limited owing to paradoxical intracellular acidosis. Tris-hydroxymethyl aminomethane rapidly corrects intracellular acidosis, restoring hepatic lactate clearance through the Cori cycle.