A 66-Year-Old Woman With Sudden Onset of Disseminated Intravascular Coagulation, Lactic Acidosis, and Hypoglycemia.
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 × 109/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 × 109/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.
Department of Medicine, University of Minnesota, Minneapolis, MN. Electronic address: henkl004@umn.edu.
Benjamin
B
Henkle
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN.
Patrick
P
Arndt
D000140:Acidosis, Lactic / Q000209:etiology* / Q000378:metabolism; D000368:Aged; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology* / Q000378:metabolism; D008223:Lymphoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000378:metabolism; D008479:Mediastinal Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000378:metabolism; D014057:Tomography, X-Ray Computed