Hyperlactataemia and Lactic Acidosis
Diagnosis, Prevention and Management
Risk factors
- HCV/HBV co-infection
- Use of ribavirin
- Liver disease
- Low CD4 count
- Pregnancy
- Female sex
- Obesity
Prevention/Diagnosis
- 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
Symptoms
- 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 |
|
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 |
- 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 the person.
Stop NRTIs.
Provide iv 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 not proven