Statin precipitated lactic acidosis?
An 82 year old woman was admitted with worsening dyspnoea. Arterial blood gases were taken on air and revealed a pH of 7.39, with a partial pressure of CO2 (pCO2) of 1.2 kPa, pO2 of 19.3 kPa, HCO3 of 13.8 mmol/litre, and base excess of -16.3 mmol/litre: a compensated metabolic acidosis with hyperventilation induced hypocapnia, which is known to be a feature of lactic acidosis. There was also an increased anion gap ((Na140 + K4.0) - (Cl 106 + HCO3 13.8) = 24.2 mEq/litre (reference range, 7-16)), consistent with unmeasured cation. Lactate was measured and found to be raised at 3.33 mmol/litre (reference range, 0.9-1.7). After exclusion of common causes of lactic acidosis Atorvastatin was stopped and her acid-base balance returned to normal. Subsequently, thiamine was also shown to be deficient. The acidosis was thought to have been the result of a mitochondrial defect caused by a deficiency of two cofactors, namely: ubiquinone (as a result of inhibition by statin) and thiamine (as a result of dietary deficiency).
Neale
R
R
Queen's Hospital, Belvedere Road, Burton-on-Trent, Staffordshire, DE13 0RB, UK.
Reynolds
T M
TM
Saweirs
W
W
D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000069059:Atorvastatin; D004032:Diet; D005260:Female; D006538:Heptanoic Acids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D011758:Pyrroles / Q000009:adverse effects* / Q000627:therapeutic use; D013832:Thiamine Deficiency / Q000150:complications*; D014451:Ubiquinone / Q000172:deficiency
D000924:Anticholesteremic Agents; D006538:Heptanoic Acids; D011758:Pyrroles; D014451:Ubiquinone; D000069059:Atorvastatin