Jung Tae Yang, Jun Dae Won, Lee Kang Nyeong, Lee Hang Lak, Lee Oh Young, Yoon Byung Chul, Choi Ho Soon
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
Medicine (Baltimore). 2017 Jun;96(25):e7133. doi: 10.1097/MD.0000000000007133.
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.
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.
With no infection, normal diagnostic paracentesis, and urinalysis together with high anion gap and increased blood lactate levels suggested lactic acidosis.
TDF was stopped, and haemodialysis was performed to control lactic acidosis.
Although stopping TDF instantly and treating lactic acidosis using hemodialysis, the patient died.
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.
最近，替诺福韦酯（TDF）已被广泛用作慢性乙型肝炎（CHB）感染的一线治疗药物。尽管TDF能成功抑制病毒，但使用TDF时存在肾衰竭和乳酸性酸中毒的可能性，尤其是在合并人类免疫缺陷病毒感染的患者中。然而，在单纯CHB感染患者中从未有过TDF诱发乳酸性酸中毒的报道。
一名59岁男性因乙型肝炎合并肝硬化接受TDF治疗。服用TDF十天后，出现恶心、呕吐和腹痛。出现了高阴离子间隙酸中毒，乳酸水平升高（pH 7.341，pCO2 29.7 mmHg，HCO3- 15.6 mmHg，乳酸3.2 mmol/L，阴离子间隙15.4 mEq/L）。
无感染，诊断性腹腔穿刺和尿液分析正常，同时高阴离子间隙和血乳酸水平升高提示乳酸性酸中毒。
停用TDF，并进行血液透析以控制乳酸性酸中毒。
尽管立即停用TDF并使用血液透析治疗乳酸性酸中毒，但患者仍死亡。
虽然TDF患者发生致命性乳酸性酸中毒非常罕见，但对于失代偿期肝硬化患者应密切观察，牢记乳酸性酸中毒的可能性。
