A 66-Year-Old Woman With Sudden Onset of Disseminated Intravascular Coagulation, Lactic Acidosis, and Hypoglycemia

• Published in: Chest Vol. 151; no. 2; p. e41
• Main Authors: Henkle, Benjamin, Arndt, Patrick
• Format: Journal Article
• Language: English
• Published: United States 01.02.2017
• Subjects: Acidosis, Lactic - etiology; Acidosis, Lactic - metabolism; Aged; Disseminated Intravascular Coagulation - etiology; Female; Humans; Hypoglycemia - etiology; Hypoglycemia - metabolism; Lymphoma - complications; Lymphoma - diagnostic imaging; Lymphoma - metabolism; Mediastinal Neoplasms - complications; Mediastinal Neoplasms - diagnostic imaging; Mediastinal Neoplasms - metabolism; Tomography, X-Ray Computed
• ISSN: 1931-3543
• DOI: 10.1016/j.chest.2016.08.1441

A 66-year-old woman presented to an urgent care clinic for 2 to 3 weeks of general malaise, nausea/vomiting, night sweats, and dyspnea. On examination, she was tachycardic, and her laboratory evaluation was normal except for a lactate level of 4.4 mmol/L and platelet count of 118 × 10 /L. CT imaging was performed. Two days later in the follow-up clinic, the patient's international normalized ratio (INR) was elevated, and she was hospitalized with initial findings of disseminated intravascular coagulation (DIC) (ie, INR > 10, platelets 97 × 10 /L, fibrinogen < 60 mg/dL, positive D-dimer result). Bone marrow aspirate and peripheral blood smears were unrevealing. On day 4 of her hospitalization, the patient developed severe lactic acidosis (24 mmol/L) and hypoglycemia (11 mg/dL), and she was transferred to our institution. The patient had a history of a benign ovarian tumor, was a nonsmoker, did not drink alcohol, and was not taking any medications prior to admission. No ingestions or environmental exposures were noted.