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Case 5: Lactic Acidemia

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B 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.

This answer is correct. Patients with lactic acidemia generally have a gradual onset of multiple systemic symptoms; the patient’s symptoms described in this case are typical of symptoms associated with lactic acidemia. Because many of the symptoms associated with lactic acidemia are non-specific, a diagnosis requires a laboratory documentation of a serum lactate level greater than 2 mmol/L (18 mg/dL). Lactic acidemia is a potential complication caused by drugs in the nucleoside reverse transcriptase inhibitor (NRTI) class, with stavudine and didanosine having been the most frequently incriminated drugs.


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