A 54-year-old housewife with acute myeloblastic leukemia in relapse was admitted because of vomiting, abdominal pain, palpitation and dyspnea. The hemoglobin value was 5.9 g/dl, RBC 310×104/μl, platelets 104/μl, and WBC 50.7×104/μl with 76% myeloblasts. Chromosome analysis revealed monosomy 7. Arterial blood pH was 7.127, PO2 18.0 mmHg, Pco2 46 mmHg, HCO-3 13.1 mmol/l. Serum Na value was 135 meq/l, K 5.4 mEq/l, Cl 100 mEq/l, blood glucose 87 mg/dl and creatinine 1.2 mg/dl. Serum lactate level was 132.1 mg/dl, pyruvate 4.9 mg/dl. A diagnosis of acute myeloblastic leukemia with lactic acidosis was made. The patient died soon after admission. Marked leukemic infiltrates were found in the liver, spleen, bilateral lungs and bone marrow at postmortem examination, which might account for the tissue hypoxia. Specimens of the liver obtained at autopsy were examined for key enzymes of gluconeogenesis. Reductions in enzymatic activities of pyruvate carboxylase, phosphoenolpyruvate carboxykinase, fructose-1-6-diphosphatase and glucose-6-phosphatase were observed. It is suggested that the suppressed gluconeogenesis due to leukemic infiltrates in the liver may be one of the causes of severe lactic acidosis.
