Treatment of a patient with severe lactic acidosis and multiple organ failure due to mitochondrial myopathy: A case report

Table 1 Time course of lactate levels and hemodynamic support during the first 7 d

Days	Norepinephrine (µg/kg/min)	Epinephrine (µg/kg/min)	Lactic acid (mmol/L)	Blood pressure (mmHg)	ECMO
1	18.2	1	31	70/30	+
2	10.8	0.5	27	110/70	+
3	3.2	0.1	15	120/65	+
4	1.8	0.05	11.5	125/73	+
5	0.16	-	9.2	130/75	+
6	0.04	-	6.8	140/75	+
7	-	-	3.4	120/73	-

“+” indicates use during hospitalization; “_” indicates not use during hospitalization. As the treatment progressed, the patient's vasoactive drugs became less and less, lactic acid became lower and lower, and extracorporeal membrane oxygenation was withdrawn. ECMO: Extracorporeal membrane oxygenation.

Table 2 Development of muscle strength

Days	Cervical muscle paralysis	Respiratory muscle paralysis	Proximal muscle strength	Distal muscle strength	Myalgia	Amyotrophy
On admission	-	-	4	4	-	-
7	+	+	0	0	+	-
10	+	+	0	1	+	-
20	-	+	0	1-2	+	+
30	-	+	0	2	+	+
40	-	+	1-2	3	+	+
60	-	-	2-3	3-4	-	+
90	-	-	4	5	-	+
120	Walk with assistance
180	Walk independently

”+” indicates positive signs during hospitalization; ”-” indicates negative signs during hospitalization. Clinical physical examination according to the situation of muscle strength, can be roughly divided into 0 to 5, a total of 6 levels, and the specific score is as follows: (1) 0, complete paralysis of the limb, and muscle strength can not be seen or measured by the naked eye muscle contraction; (2) 1, muscle strength can be seen by the naked eye muscle fiber fibrillation, but can not form movement; (3) 2, the limbs can move in parallel on the bed, but can not resist gravity, that is, can not lift off the bed surface; (4) 3, the limbs can resist gravity, can lift off the bed, but can not resist resistance; (5) 4, muscle strength for the limb can resist some resistance; and (6) 5, muscle strength is completely normal.