Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0044-1791999
Letter to the Editor

An Unusual Case of Alarming Lactic Acidosis: Brain Metabolic Cross-Talk

Sivakumar R. 
1   Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Sumit Roy Chowdhury 
1   Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Karma Ongmu Bhutia
1   Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Suman Sokhal
1   Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

A 39-year-old male with a BMI of 30.8 kg/m2 and a normal medical history underwent excision of a left orbito-cavernal hemangioma (4 × 2 × 2 cm) under general anesthesia. Balanced anesthesia and fluid management guided by pulse pressure variation (kept below 12%) were employed. Despite stable hemodynamics and normal blood sugar levels, arterial blood gas (ABG) analysis revealed a progressive rise in lactate levels, reaching 10.6 mmol/L, accompanied by acidemia. Systemic hypoperfusion was ruled out by maintaining mean arterial pressure between 70-80 mm Hg, ensuring a capillary refill time of less than 3 seconds, and confirming a central venous oxygen saturation of 72%. With a total blood loss of 800 mL, one unit of packed red blood cells was transfused due to concerns about decreased microcirculation and tissue hypoxia. After 10 hours of surgery, sodium bicarbonate (NaHCO3) was administered to mitigate metabolic acidosis and its potential impact on intracranial pressure. Postoperatively, lactate levels remained elevated (8-9 mmol/L), but with continued NaHCO3 infusion, lactate reduced to 6.4 mmol/L, allowing extubation. The patient's lactate normalized by the evening, and recovery was uneventful. This case highlights the significant metabolic disturbances, particularly lactic acidosis, that can arise during brain tumor surgery due to prolonged operative times, large tumor size, higher BMI, and stress-induced metabolic derangements. Awareness and prompt management of these disturbances are crucial for successful patient outcomes.

Keywords

brain metabolic cross-talk - brain tumors - craniotomy - hyperlactatemia - lactic acidosis

Authors' Contributions

All authors contributed to the study in several key areas. They participated in the literature search, data acquisition, and data analysis. Each author was actively involved in the preparation, editing, and review of the manuscript. Furthermore, all authors assume responsibility as guarantors, ensuring the accuracy and integrity of the work.


The manuscript has been read and approved by all the authors, the requirements for authorship, as stated earlier in this document, have been met, and each author believes that the manuscript represents honest work.




Publication History

Article published online:
05 November 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Lawton TO, Quinn A, Fletcher SJ. Perioperative metabolic acidosis: the Bradford Anaesthetic Department Acidosis Study. J Intensive Care Soc 2019; 20 (01) 11-17
    CrossrefPubMedGoogle Scholar
  • 2 Romero-Garcia S, Moreno-Altamirano MM, Prado-Garcia H, Sánchez-García FJ. Lactate contribution to the tumor microenvironment: mechanisms, effects on immune cells and therapeutic relevance. Front Immunol 2016; 7: 52
    CrossrefPubMedGoogle Scholar
  • 3 Reuss AM, Groos D, Buchfelder M, Savaskan N. The acidic brain-glycolytic switch in the microenvironment of malignant glioma. Int J Mol Sci 2021; 22 (11) 5518
    CrossrefPubMedGoogle Scholar