title: Fatal lactic acidosis during antiretroviral therapy.
abstract: OBJECTIVE
  To describe the first pediatric case of fatal lactic acidosis in an antiretroviral-treated child with human immunodeficiency virus (HIV) infection.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Pediatric intensive care unit.
  
  
  METHODS
  A patient with fatal antiretroviral therapy-associated type B lactic acidosis.
  
  
  METHODS
  None.
  
  
  RESULTS
  We report the case of a 5-yr-old girl with HIV infection, receiving ritonavir, stavudine, and didanosine, who presented with a 10-day history of nausea and vomiting. Severe lactic acidosis was found. Her clinical condition worsened, with progressive increase in serum lactate, despite aggressive supportive therapy, including intravenous alkali and continuous arteriovenous hemodiafiltration.
  
  
  CONCLUSIONS
  Fatal lactic acidosis is a complication of antiretroviral therapy in pediatric HIV patients, which has not been previously reported in children. Early recognition of mitochondrial dysfunction in these patients could prevent the development of fatal lactic acidosis.
authors.affiliation: Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain. crey@hcas.sespa.es
authors.forename: Corsino
authors.initials: C
authors.lastname: Rey
authors.forename: Soledad
authors.initials: S
authors.lastname: Prieto
authors.forename: Alberto
authors.initials: A
authors.lastname: Medina
authors.forename: Carlos
authors.initials: C
authors.lastname: Pérez
authors.forename: Andrés
authors.initials: A
authors.lastname: Concha
authors.forename: Sergio
authors.initials: S
authors.lastname: Menéndez
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced*; D002675:Child, Preschool; D016049:Didanosine / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D017320:HIV Protease Inhibitors / Q000009:adverse effects*; D006801:Humans; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*; D019438:Ritonavir / Q000009:adverse effects*; D018119:Stavudine / Q000009:adverse effects*
chemical_list: D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D018119:Stavudine; D016049:Didanosine; D019438:Ritonavir