The Poison Review

Pharmacologically-Induced Metabolic Acidosis.  Liamis G et al.  Drug Saf 2010 May 1; 33:371-391.

Abstract

This somewhat wordy article is a complete review of drug-induced metabolic acidosis, and well worth reading for those interested in expanding their knowledge beyond the mnemonic MUDPILES or reviewing the 4 types of renal tubular acidosis.  There is so much detail here that the paper is impossible to summarize, but here are some of its clinical pearls:

•  Most of the patients who develop metformin-associated lactic acidosis had been taking the drug despite have a contraindication to its use, such as renal insufficiency or severe underlying disease.

•  Antiviral therapy, especially nucleotide reverse transcriptase inhibitors, have been associated with life-threatening metabolic acidosis. Drugs implicated most often include didanosine, stavudine, and zidovudine.

•  Linezolid impairs mitochondrial function and can cause metabolic acidosis, usually after prolonged therapy.

• The occurrence of metabolic acidosis in patients on propofol may herald onset of propofol infusion syndrome, which has a mortality rate of greater than 80%.

•  Occult laxative abuse is on the differential diagnosis for a patient with unexplained hyperchloremic metabolic acidosis.