An Exercise in Clinical Reasoning: Use of Social Context in Diagnosing an Elevated Lactate: An Exercise in Clinical Reasoning: Use of Social Context: Chang et al.

The article discusses a case study of a 65-year-old man with chronic rhinosinusitis and an elevated lactate level, leading to a diagnosis of type B lactic acidosis secondary to stage IV NK/T-cell lymphoma. The patient's social context, including his migration history from China to the U.S., was considered in the diagnostic process to understand possible exposures and risks. The article emphasizes the importance of integrating social context into clinical reasoning while avoiding premature conclusions based on race or geographic identifiers. The case highlights the need for hospitalists to maintain a high suspicion for type B lactic acidosis in cases of severe and unexplained lactic acidosis, especially when considering occult hematologic malignancies. [Extracted from the article]