Enliven: Journal of Anesthesiology and Critical Care Medicine

Lactic Acidosis during Anesthesia for Glioblastoma Multiforme Resection: The Warburg Effect
Author(s): Farhan Mazhar, MD and David M. Rothenberg, MD, FCCM

The purpose of this case report is to present a case of significant lactic acidosis without clinical evidence of hypoperfusion, and show that it is likely due to lactic acid production by the brain tumor glioblastoma multiforme (GBM), the so-called Warburg Effect.

Observational Methods (vitals and lab tests conducted) were conducted for a 57 year old female.

Final pathologic report of the tumor was recurrent GBM and therapy related changes. Hyperlactatemia and chronic lactic acidosis were attributed to her brain tumor as a diagnosis of exclusion.

Lactic acidosis due to the Warburg Effect was a diagnosis of exclusion, and coupled with the patients’ hyperchloremic metabolic acidosis, caused a significant metabolic acidosis. Although perioperative lactic acidosis, however mild, is usually a marker for tissue hypoperfusion and/or cellular hypoxia, the anesthesiologist must be aware of the wider differential diagnosis including drugs, thiamine deficiency, and tumor based lactate production.