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

Asian journal of neurosurgery Pub Date : 2024-11-05 eCollection Date: 2025-03-01 DOI:10.1055/s-0044-1791999
Sivakumar R, Sumit Roy Chowdhury, Karma Ongmu Bhutia, Suman Sokhal
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Abstract

A 39-year-old male with a BMI of 30.8 kg/m 2 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.

一个不寻常的乳酸性酸中毒病例:脑代谢串扰。
39岁男性,BMI 30.8 kg/ m2,正常病史,全麻下行左侧眶海绵状血管瘤(4 × 2 × 2 cm)切除术。采用脉压变化指导的平衡麻醉和液体管理(保持在12%以下)。尽管血流动力学稳定,血糖水平正常,但动脉血气(ABG)分析显示乳酸水平逐渐上升,达到10.6 mmol/L,并伴有酸血症。通过维持平均动脉压在70-80毫米汞柱之间,确保毛细血管再充血时间小于3秒,并确认中心静脉氧饱和度为72%,排除了全体性灌注不足。由于担心微循环减少和组织缺氧,总失血量为800 mL,输注1单位填充红细胞。手术10小时后,给予碳酸氢钠(NaHCO3)以减轻代谢性酸中毒及其对颅内压的潜在影响。术后,乳酸水平仍然升高(8-9 mmol/L),但持续NaHCO3输注后,乳酸水平降至6.4 mmol/L,允许拔管。患者的乳酸水平在晚上恢复正常,恢复过程平稳。该病例突出了脑肿瘤手术期间由于手术时间延长、肿瘤体积大、BMI升高和应激引起的代谢紊乱而出现的显著代谢紊乱,特别是乳酸性酸中毒。对这些干扰的认识和及时管理对患者的成功治疗至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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