1/7. Lactic acidosis and hepatic steatosis associated with use of stavudine: report of four cases.BACKGROUND: An association between use of zidovudine and didanosine and a rare but life-threatening syndrome of hepatic steatosis, lactic acidosis, and myopathy has been reported. OBJECTIVE: To describe the syndrome of hepatic steatosis, lactic acidosis, and myopathy in four patients taking stavudine. DESIGN: Case series. SETTING: A community hospital in washington, D.C., and National Institutes of health Clinical Center, Bethesda, maryland. patients: Two men and two women with hiv-1 infection who were taking stavudine presented with lactic acidosis and elevated levels of aminotransferases. All patients required intensive care. MEASUREMENTS: Levels of lactic acid, alanine aminotransferase, aspartate aminotransferase, amylase, and lipase; computed tomography of the abdomen; liver biopsy (two patients); and muscle biopsy (two patients). RESULTS: Histologic findings consistent with mitochondrial injury confirmed the diagnosis of hepatic or muscle abnormality. CONCLUSION: Because hepatic steatosis may be life-threatening, physicians should consider it as a possible cause of elevated hepatic aminotransferase levels among patients taking stavudine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Symptomatic lactic acidosis in hospitalized antiretroviral-treated patients with human immunodeficiency virus infection: a report of 12 cases.We retrospectively investigated the clinical and histopathologic features of hospitalized patients infected with human immunodeficiency virus who had symptomatic lactic acidosis syndrome at a university teaching hospital during 1995-2000. Twelve patients were identified, 11 during 1998-2000; of these, 5 died with rapid progression to otherwise unexplained multiple-organ failure. All had extensive prior exposure to nucleoside analog reverse-transcriptase inhibitors (NRTIs). At presentation, the most commonly identified NRTI component of antiretroviral regimens was stavudine plus didanosine. Eleven patients presented with abdominal pain, nausea, and/or emesis. Eight patients had prior acute weight loss (mean [ /-SD], 12 /-5.3 kg). Median venous plasma lactate levels were > or =2-fold greater than the upper limit of normal (2.1 mmol/L). serum transaminase levels were near normal limits at presentation. Histopathologic studies confirmed hepatic macrovesicular and microvesicular steatosis in 6 patients. Concurrent chemical pancreatitis was identified in 6 patients. The increasing number of cases identified during the study period suggests that physicians better recognize symptomatic lactic acidosis and/or that cumulative NRTI exposure may increase the risk for this syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. High doses of riboflavin and thiamine may help in secondary prevention of hyperlactatemia.Lactic acidosis is the most dramatic manifestation of nucleoside reverse transcriptase inhibitor (NRTI)-associated mitochondrial dysfunction. The optimal management of subjects who recover from an episode of lactic acidosis--or its milder form, symptomatic hyperlactatemia--remains unclear. Most physicians opt to restart NRTI-sparing regimens, but such an option may not be available for heavily antiretroviral-experienced patients. Therefore, there is a need to investigate ways to prevent the recurrence of hyperlactatemia in patients who require NRTI-based therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Metabolic acidosis and hepatic steatosis in two HIV-infected patients on stavudine (d4T) treatment.Nucleoside analog reverse transcriptase inhibitors (NRTI) have been used to treat HIV-infected patients for >10 years. Some severe adverse events have been attributed to mitochondrial dysfunction. Since 1991, cases of severe lactic acidosis have been reported in association with nucleoside therapy. Our objective was to report two cases of metabolic acidosis and hepatic steatosis in patients receiving stavudine (d4T) and to review the literature. A male and a female, 47 and 45 years of age, respectively, presented with abdominal pain, nausea, vomiting, and weakness after 9 and 6 months, respectively, of treatment with stavudine. At presentation, both patients had severe metabolic acidosis and liver failure. ultrasonography showed hepatic steatosis (confirmed by biopsy in one case). All antiretroviral drugs were withdrawn and patients were treated with bicarbonate. Both patients developed fulminant liver dysfunction and multiple organ failure. We reviewed the literature and found 75 cases of lactic acidosis and hepatic steatosis associated with use of NRTI; 57 of these patients received d4T (76%). Of all cases reported in association with nucleoside therapy, 63% were females and mortality was 47%. General weakness, hepatic enzyme elevation, and liver steatosis are data that should alert physicians to this serious adverse event and to respond with prompt interruption of antiretroviral drugs and measurement of lactic acid in plasma. It is important to report serious adverse events in commercially released drugs to know prevalence in an exposed population. physicians should be aware of risk and early signs of this serious adverse event.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Biguanide-associated lactic acidosis. Case report and review of the literature.PURPOSE--The biguanides are a class of oral hypoglycemic agents that are commonly used in the treatment of diabetes mellitus. Such agents include metformin, phenformin, and buformin. The use of phenformin was discontinued in the united states in 1976 because of probable association with lactic acidosis. However, metformin is currently in common use in many parts of the world. In this report, we describe a patient with severe lactic acidosis secondary to metformin administration, and review the literature relevant to biguanide-associated lactic acidosis. PATIENT--We describe a diabetic man with end-stage renal failure and diabetes mellitus who was hospitalized with life-threatening lactic acidosis (lactate, 10.9 mmol/L). Unbeknownst to the hospital staff, he was being treated with metformin, which had been prescribed in indonesia. RESULTS--Arterial blood gas analysis revealed a pH of 6.76 and a bicarbonate level of 1.6 mmol/L prior to treatment. Following therapy, which included oxygen, volume expansion, other supportive therapy, and hemodialysis, the patient completely recovered and was discharged from the hospital. CONCLUSIONS--Lactic acidosis can complicate biguanide therapy in diabetic patients with renal insufficiency. We review the literature relevant to the pathogenesis and therapy of biguanide-associated lactic acidosis. physicians who have completed their training after 1976 may not be familiar with metformin and other biguanides, but with the increasing numbers of immigrants to the united states, physicians should be aware of the potential complications of these medications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. thiamine deficiency as a cause of metabolic acidosis.Since its introduction in the 1970s, total parenteral nutrition (TPN) has gained popularity as a means of nutritional support for patients who cannot orally ingest sufficient calories and nutrients to promote wound healing or recovery from debilitating illness. As this treatment modality is employed among heterogenous groups of patients, a number of potential problems have been identified. Fortunately, most of these difficulties can be eliminated or minimized by understanding the metabolic goals of TPN and by employing proper catheter management. One of the unusual complications, a high anion gap metabolic acidosis refractory to bicarbonate therapy, occurred in one of our patients who was receiving TPN without adequate thiamine supplementation. The casual relationship between thiamine deficiency and metabolic acidosis has been well described in the literature, but remains under-recognized by many physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Acute necrotizing pancreatitis, lactic acidosis and prolonged hypoglycemia in a hemodialysed patient--a logical but unfortunately fatal combination.A hemodialysed patient with abdominal pain, severe lactic acidosis and prolonged hypoglycemia is described. The diagnosis of acute necrotizing pancreatitis was delayed and the patient died from both systemic and peripancreatic complications of the acute pancreatitis. The article deals with the problem of diagnosing acute pancreatitis in an end-stage renal failure (ESRF) patient; on the possible surgical options open to the physician in the management of acute pancreatitis and on a pathophysiological explanation behind both the lactic acidosis and hypoglycemia in this patient.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |