Acute lymphoblastic leukemia presenting with lactic acidosis and renal tubular dysfunction.

Acute lymphoblastic leukemia (ALL) in children can rarely present with severe lactic acidosis in the absence of a high white blood cell count or other complications. Renal tubular dysfunction with hypercalciuria and hypocalcemia in the absence of pre-existing renal disease or concurrent medications has not been described at presentation in childhood ALL. The authors describe a 7-year-old boy with ALL presenting with severe lactic acidosis and renal tubular dysfunction, both of which were refractory to conventional management and resolved rapidly with appropriate chemotherapy.