Linezolid
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Lactic acidosis: case report A 59-year-old man developed lactic acidosis during treatment with linezolid for Enterococcus faecium infection. The man, whose medical history was notable for progressive IgM Waldenstrom macroglobulinaemia, hypertension and recent necrotising pneumonia, was hospitalised due to neutropenic fever. Blood cultures on day 9 of admission grew vancomycin-resistant Enterococcus faecium. Therefore, he started receiving oral linezolid 600mg every 12 hours for 2 days, followed by IV linezolid 600mg every 12 hours for 5 days. On day 15 of admission, his vital signs were as follows: BP 121/84mm Hg, temperature 36.8°C, HR 86 beats/minute and RR 18 breaths/minute. Laboratory analyses revealed the following: venous pH 7.26, venous lactate 17 mmol/L, venous PCO2 25mm Hg, anion gap 28 meq/L, serum bicarbonate 10 meq/L, AST 74 U/L, ALT 83 U/L, total protein 8.3 g/dL, albumin 1.5 g/dL, total bilirubin 2.8 mg/dL, creatinine 1.6 mg/L, WBC count 20 400/µL, platelet count 30 000/µL, absolute neutrophil count 0/µL and LDH 1253 U/L, which were consistent with severe acidaemia (involving elevated anion gap metabolic acidosis with respiratory compensation) secondary to lactic acidosis induced by linezolid. The man’s treatment with linezolid was discontinued, and he was treated with isotonic bicarbonate. He also received calcium and thiamine. His pH, lactate and bicarbonate levels subsequently improved. Hindi J, et al. Severe Acidemia in a Patient With Waldenstrom Macroglobulinemia. Kidney International Reports 5: 1586-1589, No. 9, Sep 2020. Available from: URL: http:// 803504727 doi.org/10.1016/j.ekir.2020.06.023
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Reactions 3 Oct 2020 No. 1824
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