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Case 5: Antiretroviral Medications and Lactic Acidemia

You answered:

A The patient’s symptoms are consistent with lactic acidemia, but the normal serum bicarbonate level and normal anion gap effectively rules out lactic acidemia as a diagnosis.

This answer is incorrect. The patient’s symptoms are consistent with lactic acidemia. Although many patients with lactic acidemia have a decrease in serum bicarbonate and an increased anion gap, the presence of a normal bicarbonate or normal anion gap does not rule out lactic acidemia. Indeed, some patients with severe lactic acidemia have had a normal bicarbonate and normal anion gap.

Choose another answer:

B The patient's symptoms are consistent with lactic acidemia and a serum lactate level should be obtained to establish the diagnosis of lactic acidemia. The likely drugs responsible are stavudine and didanosine.
C The patient’s symptoms are consistent with lactic acidemia. If the diagnosis of lactic acidemia is established and it is severe, the most important measure is to immediately prescribe riboflavin.
D The patient’s symptoms are not consistent with lactic acidemia and further laboratory evaluation is not required. Didanosine-induced adrenal insufficiency is a much more likely diagnosis.

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