Case 5: Lactic Acidemia

Question | Discussion | References | CME Credit

You answered:

	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:

	The patient’s symptoms are consistent with lactic acidemia and a lactate level greater than 2 mmol/L (18 mg/dL) would establish the diagnosis of lactic acidemia. The likely drugs responsible are stavudine and didanosine.
	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.
	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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