Abstract
A case with lactic acidosis following rupture of cerebral aneurysm is presented, since lactic acidosis associated with subarachnoid hemorrhage has not previously been reported in the literature.
A 41-year-old male was brought to Tokai University Hospital because of sudden loss of consciousness 3 hours prior to admission. On admission, his respiration was 32/min and regular. Blood pressure was 90/60 mmHg. Fundoscopic examination showed preretinal hemorrhage and flaccid paralysis was observed in the four extremities. Deep tendon reflexes and plantar response had disappeared and he did not respond to painful stimuli. The cerebrospinal fluid was bloody and blood gas analysis showed metabolic acidosis (pH 7.292) with elevated blood lactate level. A diagnosis of lactic acidosis with subarachnoid hemorrhage was made. Intravenous administration of sodium bicarbonate was effective, and the arterial pH and lactate level returned to normal within 2 days, followed by improvement of vital signs. The value of serum amylase, which was normal on admission and on the 4th hospital day, suddenly increased up to 2560 SR/dl on the 5th hospital day. His condition gradually deteriorated and he died 9 days after the onset of illness.
Autopsy revealed severe subarachnoid hemorrhage, particularly around the anterior communicating artery and localized pancreatitis on the pancreas head which was assumed to have occurred on the 5th hospital day.
The possible causes of clinical lactic acidosis are discussed. However, these factors appear not to have contributed to this case, although it is difficult to exclude the possibility that acute hypoperfusion caused lactic acidosis in this case. As it has been shown by some investigators that blood lactate level is elevated significantly in patients with head injury, it is concluded that the lactic acidosis in this case was mainly attributable to the subarachnoid hemorrhage itself.
