Fatal lactic acidosis in hepatitis B virus-associated decompensated cirrhosis treated with tenofovir A case reportopen access
- Authors
- Jung, Tae Yang; Jun, Dae Won; Lee, Kang Nyeong; Lee, Hang Lak; Lee, Oh Young; Yoon, Byung Chul; Choi, Ho Soon
- Issue Date
- Jun-2017
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Keywords
- HBV; lactic acidosis; tenofovir disoproxil fumarate
- Citation
- MEDICINE, v.96, no.25
- Indexed
- SCIE
SCOPUS
- Journal Title
- MEDICINE
- Volume
- 96
- Number
- 25
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/19664
- DOI
- 10.1097/MD.0000000000007133
- ISSN
- 0025-7974
- Abstract
- Rationale: Recently tenofovir disoproxil fumarate (TDF) has been widely used as a first-line therapy for chronic hepatitis B (CHB) infection. Although TDF demonstrates successful viral suppression, the possibility of renal failure and lactic acidosis has been proposed with TDF administration, especially in human immunodeficiency virus co-infected patients. However, TDF induced lactic acidosis has never been reported in CHB mono-infected patients.
Patient concerns: A 59-year-old man received TDF for hepatitis B associated with cirrhosis. After ten days of TDF administration, nausea, vomiting and abdominal pain developed. High anion gap acidosis with elevated lactate level (pH 7.341, pCO₂ 29.7 mmHg, HCO₃-15.6mmHg, lactate 3.2mmol/L, anion gap 15.4 mEq/L) was developed.
Diagnosis: With no infection, normal diagnostic paracentesis, and urinalysis together with high anion gap and increased blood lactate levels suggested lactic acidosis.
Interventions: TDF was stopped, and haemodialysis was performed to control lactic acidosis.
Outcomes: Although stopping TDF instantly and treating lactic acidosis using hemodialysis, the patient died.
Lessons: Although, Fatal lactic acidosis is very rare in TDF patient, however, decompensated cirrhotic patients should be closely observed to keep the possibility of lactic acidosis in mind.
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