Lactic acidosis associated with standard dose linezolid in a kidney recipient with impaired renal function
Severe lactic acidosis, a mitochondrial toxicity caused by the recommended standard dosage of linezolid (LZD), may occur in patients with impaired renal function. We describe an adult male who underwent kidney transplantation with stably impaired renal function, severe dyspnea, and abdominal discomf...
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| Published in: | The Brazilian journal of infectious diseases Vol. 26; no. 1; p. 101701 |
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| Language: | English |
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01-01-2022
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| Abstract | Severe lactic acidosis, a mitochondrial toxicity caused by the recommended standard dosage of linezolid (LZD), may occur in patients with impaired renal function. We describe an adult male who underwent kidney transplantation with stably impaired renal function, severe dyspnea, and abdominal discomfort. He received a standard oral dose of LZD (600 mg twice daily) and azithromycin for three weeks with a reduced immunosuppressant dose due to pulmonary non-tuberculosis mycobacterial infection. He was alert and afebrile, with a blood pressure of 140/60 mmHg. Pertinent laboratory data showed: pH 7.12, PaCO2 13.6 mmHg; HCO3- 4.3 mmol/L and serum lactate 18.4 mmol/L. His trough serum LZD concentration reached toxic levels (21.4 μg/mL). With hemodialysis, his clinical symptoms improved, with a decline in serum LZD (9.8μg/mL) and lactate (3.2 mmol/L). Chronic standard dose LZD in patients with impaired renal function can lead to life-threatening lactic acidosis, especially in coexisting conditions that reduce LZD metabolism. |
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| AbstractList | Abstract Severe lactic acidosis, a mitochondrial toxicity caused by the recommended standard dosage of linezolid (LZD), may occur in patients with impaired renal function. We describe an adult male who underwent kidney transplantation with stably impaired renal function, severe dyspnea, and abdominal discomfort. He received a standard oral dose of LZD (600 mg twice daily) and azithromycin for three weeks with a reduced immunosuppressant dose due to pulmonary non-tuberculosis mycobacterial infection. He was alert and afebrile, with a blood pressure of 140/60 mmHg. Pertinent laboratory data showed: pH 7.12, PaCO2 13.6 mmHg; HCO3- 4.3 mmol/L and serum lactate 18.4 mmol/L. His trough serum LZD concentration reached toxic levels (21.4 μg/mL). With hemodialysis, his clinical symptoms improved, with a decline in serum LZD (9.8μg/mL) and lactate (3.2 mmol/L). Chronic standard dose LZD in patients with impaired renal function can lead to life-threatening lactic acidosis, especially in coexisting conditions that reduce LZD metabolism. Severe lactic acidosis, a mitochondrial toxicity caused by the recommended standard dosage of linezolid (LZD), may occur in patients with impaired renal function. We describe an adult male who underwent kidney transplantation with stably impaired renal function, severe dyspnea, and abdominal discomfort. He received a standard oral dose of LZD (600 mg twice daily) and azithromycin for three weeks with a reduced immunosuppressant dose due to pulmonary non-tuberculosis mycobacterial infection. He was alert and afebrile, with a blood pressure of 140/60 mmHg. Pertinent laboratory data showed: pH 7.12, PaCO2 13.6 mmHg; HCO3- 4.3 mmol/L and serum lactate 18.4 mmol/L. His trough serum LZD concentration reached toxic levels (21.4 μg/mL). With hemodialysis, his clinical symptoms improved, with a decline in serum LZD (9.8μg/mL) and lactate (3.2 mmol/L). Chronic standard dose LZD in patients with impaired renal function can lead to life-threatening lactic acidosis, especially in coexisting conditions that reduce LZD metabolism. Severe lactic acidosis, a mitochondrial toxicity caused by the recommended standard dosage of linezolid (LZD), may occur in patients with impaired renal function. We describe an adult male who underwent kidney transplantation with stably impaired renal function, severe dyspnea, and abdominal discomfort. He received a standard oral dose of LZD (600 mg twice daily) and azithromycin for three weeks with a reduced immunosuppressant dose due to pulmonary non-tuberculosis mycobacterial infection. He was alert and afebrile, with a blood pressure of 140/60 mmHg. Pertinent laboratory data showed: pH 7.12, PaCO2 13.6 mmHg; HCO3- 4.3 mmol/L and serum lactate 18.4 mmol/L. His trough serum LZD concentration reached toxic levels (21.4 [micro]g/mL). With hemodialysis, his clinical symptoms improved, with a decline in serum LZD (9.8/Ltg/mL) and lactate (3.2 mmol/L). Chronic standard dose LZD in patients with impaired renal function can lead to life-threatening lactic acidosis, especially in coexisting conditions that reduce LZD metabolism. ( |
| ArticleNumber | 101701 |
| Audience | Academic |
| Author | Liu, Wei-Ting Lin, Shih-Hua Chen, Chien-Chou |
| AuthorAffiliation | Tri-Service General Hospital Songshan Branch Tri-Service General Hospital |
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| Author_xml | – sequence: 1 givenname: Chien-Chou orcidid: 0000-0001-5167-2630 surname: Chen fullname: Chen, Chien-Chou organization: Department of Internal Medicine, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan – sequence: 2 givenname: Wei-Ting orcidid: 0000-0002-3817-4079 surname: Liu fullname: Liu, Wei-Ting organization: Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan – sequence: 3 givenname: Shih-Hua orcidid: 0000-0001-6152-4885 surname: Lin fullname: Lin, Shih-Hua email: l521116@ndmctsgh.tw organization: Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34942159$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1183/09031936.00001913 10.2215/CJN.00340118 10.1093/cid/cir842 10.1016/j.ijantimicag.2014.06.017 10.2165/00003088-200342130-00004 10.1517/17425255.2016.1166204 10.1016/j.ijantimicag.2013.02.020 10.1097/01.CCM.0000147687.06808.92 10.1007/s10156-010-0080-6 10.1016/j.ijid.2014.12.009 10.1080/14656566.2016.1182154 10.1007/s00228-017-2377-1 10.1080/14740338.2017.1335305 10.1128/AAC.00687-17 10.1056/NEJM200511243532123 10.1111/bcpt.12797 10.1128/AAC.00605-19 10.1016/j.biopha.2021.111631 10.2165/11539220-000000000-00000 10.1128/AAC.47.9.2775-2780.2003 10.1111/jcpt.13245 |
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| Keywords | Linezolid eGFR NTM LZD Chronic kidney disease TDM Lactic acidosis CKD |
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| Snippet | Severe lactic acidosis, a mitochondrial toxicity caused by the recommended standard dosage of linezolid (LZD), may occur in patients with impaired renal... Abstract Severe lactic acidosis, a mitochondrial toxicity caused by the recommended standard dosage of linezolid (LZD), may occur in patients with impaired... |
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| SubjectTerms | Acidosis, Lactic - chemically induced Acidosis, Lactic - diagnosis Adult Case Report Case studies Chronic kidney disease Complications and side effects Dosage and administration Drug therapy Humans INFECTIOUS DISEASES Kidney - physiology Kidney failure Kidneys Lactic acidosis Linezolid Linezolid - adverse effects Male Organ transplant recipients Risk factors Transplantation |
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| Title | Lactic acidosis associated with standard dose linezolid in a kidney recipient with impaired renal function |
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