Marceau et al described the evaluation for an HIV-positive patient with an elevated serum lactic acid level. This can help determine the appropriate management of the patient. The authors are from the University Hospital of Clermont-Ferrand in France.
Parameters:
(1) level of hyperlactatemia
(2) clinical findings
(3) probable cause
|
Serum Lactic Acid |
Descriptor |
|
< 2.25 mmol/L |
normal |
|
2.25 - 5.0 mmol/L |
hyperlactatemia |
|
> 5.0 mmol/L |
lactic acidosis |
Clinical symptoms of lactic acidosis:
(1) asthenia (generalized weakness and fatigue)
(2) nausea
(3) diarrhea
(4) weight loss > 10%
(5) muscle cramps
(6) myalgia
(7) cough
(8) dyspnea
Criteria for severe lactic acidosis:
(1) serum lactic acid > 5.0 mmol/L
(2) arterial pH < 7.3 or bicarbonate < 20 mmol/L
(3) multiorgan failure
|
Serum Lactate |
Clinical Findings |
Management |
|
< 2.25 mmol/L |
|
monitor lactate every 6 months |
|
2.25 - 5.0 mmol/L |
asymptomatic |
monitor lactate every 6 months |
|
2.25 - 5.0 mmol/L |
few to mild symptoms |
monitor every 1-2 months, consider change in NRTI therapy |
|
> 5.0 mmol/L |
mild to moderate symptoms |
monitor every 1-2 months, consider change in NRTI therapy |
|
> 5.0 mmol/L |
severe disease |
monitor lactate as often as clinically indicated; interrupt NRTI therapy; correct underlying conditions if possible |
Purpose: To evaluate an HIV-positive patient for hyperlactatemia using the approach of Marceau et al.
Specialty: Endocrinology, Clinical Laboratory, Emergency Medicine, Critical Care
Objective: laboratory tests, options
ICD-10: B23.8, E87.2,
