A51-55 The Warburg Effect, a Metabolic Tug of War: Tumor Glycolysis Leading to Hypoglycemia and Lactic Acidosis

The Warburg effect, first described by Otto Warburg in the 1920s, refers to the phenomenon in which cancer cells preferentially utilize glycolysis for energy production, converting glucose to lactate even in the presence of sufficient oxygen and functional mitochondria. It has been reported to occur in high-turnover malignancies but can also occur in normal proliferating tissues and under specific physiological stress conditions. Although the Warburg effect is associated with poor outcomes, our patient had a favorable hospitalization course and was eventually discharged home. The patient is an 80-year-old male with a past medical history of type II diabetes, hypertension, and hyperlipidemia who presented to the emergency department with syncope. He was recently hospitalized for a gastrointestinal (GI) bleed and diagnosed with diffuse large B-cell lymphoma after an esophagogastroduodenoscopy (EGD) showed a large, fungating, infiltrative, circumferential mass in the stomach. Tumor cells were positive for CD20, PAX5, MUM1, BCL6, c-Myc, and CD10. The physical exam was unremarkable. His blood work revealed persistent hypoglycemia despite treatment, with glucose levels as low as 17 mg/dL. Additionally, he was found to have lactic acidosis 5.2 mmol/L and elevated uric acid 10.9 mg/dL. He was admitted to the intensive care unit (ICU) for resistant hypoglycemia despite multiple ampules of D50 and a D10 drip, and was started on a D20 drip via a central line. Imaging with computed tomography (CT) revealed increased wall thickness of the stomach, accompanied by lymphadenopathy in the anterior cardiophrenic, paragastric, epigastric, and aortocaval areas. Additional blood work uncovered acute kidney injury with elevated creatinine and BUN, metabolic acidosis, and microcytic anemia. The infectious workup was unremarkable. His hypoglycemia was attributed to the Warburg effect in the setting of lactic acidosis, and he was started on R-CHOP therapy per hematology on day two of hospitalization. Rasburicase and allopurinol were also initiated for high suspicion of tumor lysis syndrome. He later developed a deep vein thrombosis (DVT) in his left upper extremity and was started on apixaban. Blood sugars stabilized, and his lactic acidosis resolved. The patient was discharged home in stable condition to follow up with oncology for continuation of his chemotherapy regimen. Our case demonstrates the Warburg effect presenting in a patient with B-cell lymphoma. Unlike other reported cases in adults, our patient had a favorable outcome and responded well to treatment. This highlights the importance of early recognition and initiation of therapy. This abstract is funded by: None