Linezolid
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Lactic acidosis in an elderly patient with renal failure: case report A 66-year-old woman with end-stage renal failure developed lactic acidosis during treatment with linezolid for an infected sacral decubitus ulcer. The woman had a prior history of diabetes mellitus, renal dysfunction and gangrene of her left toes. She underwent thrice weekly dialysis therapy. Both of her legs below the knee had been amputated. She later developed a sacral decubitus ulcer on day 23 of admission. The results from cultures identified the presence of vancomycin-resistant enterococcus and Escherichia coli. She was treated with linezolid [dosage not stated], cefepime, metronidazole and cotrimoxazole [trimethoprim/sulfamethoxazole]. Amputation above her left knee was later carried out and ongoing laboratory testing was initiated on day 35. Investigations revealed elevated serum lactic acid levels and reduced serum bicarbonate levels [time to onset not clearly stated]. Her diastolic and systolic BP ranged from 60–71 mm Hg and 100–147 mm Hg, respectively. She later underwent a stump revision prior to which her dialysis therapy was interrupted. Testing after surgery showed her serum bicarbonate level was < 10 mEq/L, subsequent investigation after dialysis revealed the following values: serum bicarbonate 18 mEq/L and serum lactate 13.2 mEq/L. Linezolid was withdrawn and the woman was treated with continuous renal replacement therapy. Her acidosis normalised. Treatment with daptomycin, cefepime and cotrimoxazole was continued and she later returned home with a serum bicarbonate level of 22 mEq/L. Sujata LM, et al. Lactic acidosis from linezolid in a hospitalized patient with kidney failure. Infectious Diseases in Clinical Practice 17: 404-406, No. 6, Nov 2009. Available from: URL: http://dx.doi.org/10.1097/IPC.0b013e31819b8bf4 803007658 USA
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Reactions 20 Mar 2010 No. 1293
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