Introduction: The Warburg effect is a rare but often fatal condition in patients with malignancies. This phenomenon, known as type B lactic acidosis, is defined by lactatemia without tissue hypoxia or hypoperfusion, in contrast to type A lactic acidosis, which usually results from either or both.
Case presentation: A male patient in his seventies with a newly diagnosed diffuse large B-cell lymphoma is admitted to the intensive care unit due to severe metabolic derangements with hypoglycemia and lactatemia. Extensive investigations ruled out alternative etiologies, strongly suggesting the Warburg effects as the underlying mechanism. Despite hemodynamic instability, chemotherapy was initiated and resulted in initial clinical improvement.
Conclusion: We propose a stepwise approach to improve the management of patients with suspected type B lactic acidosis.