LETTER
Lactic Acidosis and AIDS
Marilyn T. Haupt;
James A. Kruse; and
Richard W. Carlson
15 August 1993 | Volume 119 Issue 4 | Pages 343-345
TO THE EDITOR:
Chattha and associates [1] describe a group of seven human immunodeficiency virus (HIV)-infected patients with lactic acidosis "in the absence of hypoxemia or another obvious cause". We suspect that sepsis may be the cause of lactic acidosis in many, if not all, of their patients. Several symptoms described in these patients, including nausea, anorexia, fever, malaise, and tachypnea, are typical of patients with sepsis.
The authors stated that they ruled out sepsis "by appropriate laboratory tests and diagnostic procedures and by autopsy ...". Patients with HIV infection frequently have sepsis from occult or unusual infections that elude diagnosis by several diagnostic studies, including invasive biopsies. Blood cultures are positive in only about 50% of patients with clinical sepsis [2]. Normal values for oxygen delivery, consumption, and extraction do not exclude bacterial sepsis [3, 4] but may reflect an oxygen deficit because of increased oxygen demands and may contribute to lactic acid production.
1. Chattha G, Arieff AI, Cummings C, Tierney LM Jr. Lactic acidosis complicating the acquired immunodeficiency syndrome. Ann Intern Med. 1993; 118:37-9.
2. Bone RC, Fisher CJ Jr, Clemmer TP, Slotman GJ, Metz CA, Balk RA, et al. A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med. 1987; 317:653-8.
3. Gilbert EM, Haupt MT, Mandanas RT, Huaringa AJ, Carlson RW. The effect of fluid loading, blood transfusion, and catecholamine infusion on oxygen delivery and consumption in patients with sepsis. Am Rev Respir Dis. 1986; 134:873-8.
4. Ahmed AJ, Kruse JA, Haupt MT, Chandrasekar PH, Carlson RW. Hemodynamic response to gram-positive versus gram-negative sepsis in critically ill patients with and without circulatory shock. Crit Care Med. 1991; 19:1520-5.
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