Index - 28 - 29 - 30/31 - 32/33/34 - 35 - 36/37/38/39 - 40/41 - 42/43 - 44/45/46 - 47/48 - 49 - 50/51/52/53
54/55 - 56 - 57/58 - 59 - 60/61 - 62 - Pages online: A - B - C - D - E - F - G - References
HYPERLACTATAEMIA: DIAGNOSIS, PREVENTION AND MANAGEMENT
Risk factors Prevention / Diagnosis Symptoms
  • Use of ddI> d4T > ZDV
  • HCV/HBV co-infection
  • Use of ribavirin
  • Liver disease
  • Low CD4 cell count
  • Pregnancy
  • Female sex
  • Obesity
  • Avoid d4T + ddI combination
  • Routine monitoring of serum lactate levels not recommended - does not predict risk of lactic acidosis.
  • Measurement of serum lactate, bicarbonate & arterial blood gases+pH indicated in case of symptoms suggestive of hyperlactataemia
  • Close monitoring for symptoms if > 1 risk factor
  • Hyperlactataemia: unexplained nausea, abdominal pain, hepatomegaly, elevated ALT and/or AST, weight loss
  • Acidaemia: asthenia,dyspnoea, arrhythmias
  • Guillain-Barré-like syndrome
 
Management
Serum Lactate (mmol/L) Symptoms Action
>5 i Yes/No
  • Repeat test under standardized conditions to confirm & obtain arterial pH and bicarbonate i
  • If confirmed, exclude other causes
    • Arterial pH ↓ and/or bicarbonate ↓ i: Stop NRTIs
    • Arterial pH and/or bicarbonate normal: Consider switch from high to low risk NRTI & monitor carefully OR Stop NRTI’s
2-5 Yes Exclude other causes; if none found: watchfully follow up OR consider switch from high to low risk NRTI, OR Stop NRTI
2-5 No

Repeat test

  • if confirmed: watchfully follow up
<2   None
i Lactic acidosis is a rare but life-threatening situation usually associated with symptoms; high risk if serum lactate > 5 and especially > 10 mmol/L.
 
Management of lactic acidosis (irrespective of serum-lactate level):
Admit patient. Stop NRTIs. Provide intravenous fluids. Vitamin supplementation can be used (vitamin B complex forte 4 ml bid, riboflavin 20 mg bid, thiamine 100 mg bid; L-carnitine 1000 mg bid), although benefit is unproven