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Lactic Acidosis Complicating the Acquired Immunodeficiency Syndrome

Geetinder Chattha, MD; Allen I. Arieff, MD; Cary Cummings, MD; and Lawrence M. Tierney Jr., MD
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From the Veterans Affairs Medical Center and the University of California School of Medicine, San Francisco, California. Requests for Reprints: Allen I. Arieff, MD, Department of Medicine (111 G), Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, California 94121. Acknowledgments: The authors thank Drs. T. G. Patel, D. J. Connito, and P. Pointier of the Nephrology Service, Naval Hospital, Portsmouth, Virginia, and Dr. H. Boroujerdi, Department of Medicine, St. Raphael Hospital, Oakville, Connecticut, for permission to report data on patients under their care. Grant Support: In part by the Research Service of the Veterans Affairs Medical Center, San Francisco, California. Dr. C. Cummings is a Fellow of the National Kidney Foundation.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1993;118(1):37-39. doi:10.7326/0003-4819-118-1-199301010-00007
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Lactic acidosis has been reported in patients with the acquired immunodeficiency syndrome (AIDS) only in association with tissue hypoxia. From 1989 to 1991, seven patients with human immunodeficiency virus (HIV) infection who had lactic acidosis without obvious cause were evaluated. Nine normovolemic patients without acidosis or hypoxia served as controls. Findings in the patients included the following: pH, 7.22 ± 0.07; bicarbonate, 7.0 ± 2.4 mmol/L; and lactate, 14.3 ± 2.6 mmol/L. Patients and controls did not differ regarding cardiac index, PO2, oxygen extraction ratio, and systemic oxygen delivery or utilization. Four patients with AIDS died of overwhelming metabolic acidosis, but the three other patients were discharged from the hospital. Autopsy in the four patients who died showed no obvious cause for lactic acidosis. The normal oxygen delivery, utilization, and extraction suggest that increased hyperlactatemia occurred for reasons other than hypoxia. Thus, patients with AIDS but without hypoxia can develop severe lactic acidosis that is not necessarily fatal.


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Figure 1.
Oxygen delivery, oxygen utilization, and cardiac index in three patients with the acquired immunodeficiency syndrome (AIDS) and lactic acidosis and in nine control patients.

The cardiac index and oxygen delivery and utilization are all within one standard deviation (SD) of the control values. Data are presented as mean ±SD.

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