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Description
The Warburg effect, first described in the 1920s by Otto Warburg, refers to "aerobic glycolysis"-a phenomenon in which malignant cells preferentially produce large amounts of lactate despite adequate oxygen availability. This effect is a recognized cause of type B lactic acidosis, which is defined as elevated serum lactate occurring in the absence of tissue hypoxia, unlike type A lactic acidosis, which is typically due to hypoperfusion or shock. Type B lactic acidosis is most associated with underlying conditions such as malignancy, liver disease, or certain medications. The Warburg effect is particularly seen in hematologic malignancies such as leukemia and lymphoma. In critically ill patients, where elevated lactate levels are often attributed to sepsis or ischemia, recognizing type B lactic acidosis due to the Warburg effect can be especially challenging, potentially delaying diagnosis.
A 63-year-old male with a recent diagnosis of T-cell lymphoma presented with pneumoperitoneum identified by CT imaging at an outside hospital. He underwent a small bowel resection with primary anastomosis and placement of a Jackson-Pratt drain. On admission, his lactate level was 1.8 mmol/L. However, by hospital day 8, he developed worsening tachycardia and hypotension. A repeat CT scan revealed a growing intra-abdominal hematoma, and his lactate had risen to 10.3 mmol/L. The hematoma was treated with interventional radiology-guided embolization. Despite intravenous crystalloid resuscitation, there was only mild improvement in lactate levels. Importantly, there was no evidence of respiratory failure, ongoing sepsis, or bowel ischemia. Nevertheless, lactic acidosis persisted even as the pneumoperitoneum and hematoma began to resolve. By hospital day 11, his lactate had further increased to 11.3 mmol/L, without any clinical or radiographic signs of infection or ischemia.
The patient presented with a complex clinical picture, including pneumoperitoneum, sepsis, and poor nutritional intake, which necessitated further evaluation. In critically ill patients, elevated lactate levels in the absence of hypoxemia, shock, ischemia, or liver dysfunction should raise suspicion for type B lactic acidosis. Importantly, lactic acidosis due to the Warburg effect is often resistant to conventional treatments such as IV fluids, corticosteroids, and thiamine. Warburg effect should be considered in lymphoma patients with no clear etiology.
Publication Date
5-8-2026
Disciplines
Internal Medicine
Recommended Citation
Jurgens L, Watson N. Warburg effect in a 63-year-old T-Cell lymphoma patient with pneumoperitoneum. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.
Comments
2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2131