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Diagnostic Approach for Hyperlactatemia in HIV-Positive Patient

Purpose: To evaluate an HIV-positive patient for hyperlactatemia using the approach of Marceau et al.

Description

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

 


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Specialty

Objective

ICD-10