Lactic Acidosis: Treatment 1-4

• The treatment of lactic acidosis involves several interventions and supportive care measures.

• Immediately discontinue NRTI therapy. Resolution time of hyperlactatemia varies and can be lengthy. Reports range from 7 to 176 days in one study to 4 to 60 weeks in another study.1,2

• Supportive therapy includes intensive care monitoring and correcting the acidosis with the use of dichloroacetate and sodium bicarbonate.

• Therapeutic doses of various nutritional supplements, such as coenzyme Q10, riboflavin, thymine, and L-carnitine, may be tried to assist respiratory chain function. No data support their efficacy, although cases of recovery have been reported.3,4

References:

1. Lonergan JT, Havlir D, Behling C et al. Hyperlactatemia in 20 patients receiving NRTI combination regimens. Program and abstracts of the 7th Conference on Retroviruses and Opportunistic Infections, San Francisco, CA; Jan 30-Feb 2, 2000. Abstract 56.

2. Mokrzycki MH, Harris C, May H et al. Lactic acidosis associated with stavudine administration: a report of five cases. Clin Infect Dis. 2000;30:198-200.

3. Schramm C, Wanitschke R, Galle PR. Thiamine for the treatment of nucleoside analogue-induced severe lactic acidosis. Eur J Anaesthesiol. 1999;16(10):733-5.

4. Maulin L, Gerard Y, de la Tribonniere X et al. Emerging complications of antiretroviral therapy: symptomatic hyperlactatemia. Program and abstracts of the 39th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, CA; Sept 26-29, 1999. Abstract 1285.