After 5 days of nausea and vomiting, a man in his 60s with advanced, refractory diffuse large B-cell lymphoma involving the abdomen presented to the emergency department. The patient noted chronic, left-sided abdominal pain related to his lymphoma and normal passage of stool and flatus. He reported no other illnesses and was taking only esomeprazole. He was afebrile and normotensive with a pulse rate of 104/minute. A large, firm, tender mass located near the umbilicus was palpable in his abdomen, but there was no rigidity or rebound tenderness. Laboratory studies (Table) showed an elevated lactate level of 6.3 mmol/L (reference range, 0.7-2.2 mmol/L) (56.8 mg/dL; reference range, 6.3-19.8 mg/dL).
Chen M, Kim TY, Pessegueiro AM. Elevated Lactate Levels in a Non–Critically Ill Patient. JAMA. 2015;313(8):849-850. doi:10.1001/jama.2014.14074