title: Lactic Acidosis with Chloramphenicol Treatment in a Child with Cystic Fibrosis.
abstract: Children with cystic fibrosis are commonly colonized with multi-resistant bacteria. In such patients, infectious exacerbation may require salvage therapy with uncommonly used antimicrobials, including chloramphenicol. Chloramphenicol is rarely used nowadays because of the associated severe adverse events. We describe the case of a 15-year-old female with terminal cystic fibrosis who required intravenous (IV) chloramphenicol treatment for a Burkholderia cepacia (B. cepacia) exacerbation. The child subsequently developed lactic acidosis and secondary respiratory compensation adding to her baseline respiratory distress. Based on the Naranjo scale, the probability of chloramphenicol being the cause of the hyperlactatemia and associated respiratory distress was rated as probable, as the adverse effects resolved upon discontinuation of the drug. Subsequent genotyping for mitochondrial polymorphism (G3010A) confirmed a possible susceptibility to lactic acidosis from mitochondrial RNA-inhibiting agents such as chloramphenicol. Hyperlactatemia is a rare but life threatening adverse effect that has been previously reported with chloramphenicol exposure, but is not generally thought of. Clinicians should be aware of this potentially life threatening, but reversible adverse event. Lactate should be monitored under chloramphenicol and it should be discontinued as soon as this complication is suspected, especially in patients with low respiratory reserve.
authors.affiliation: Department of Pharmacy, CHU Sainte-Justine.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Goyer
authors.affiliation: Department of Emergency Medicine, Hôpital du Sacré-Coeur de Montréal.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Iseppon
authors.affiliation: 3Department of Pediatrics, University of Montreal.|Department of Pharmacology, University of Montreal.
authors.forename: Céline
authors.initials: C
authors.lastname: Thibault
authors.affiliation: Department of Pharmacology, University of Montreal.|5CHU Sainte-Justine Research Center.
authors.forename: Rachid
authors.initials: R
authors.lastname: Abaji
authors.affiliation: Department of Pediatrics, University of Montreal.|Department of Pharmacology, University of Montreal.|CHU Sainte-Justine Research Center.
authors.forename: Maja
authors.initials: M
authors.lastname: Krajinovic
authors.affiliation: Department of Pediatrics, University of Montreal.|Department of Pharmacology, University of Montreal.|CHU Sainte-Justine Research Center.
authors.forename: Julie
authors.initials: J
authors.lastname: Autmizguine
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000235:genetics; D000293:Adolescent; D019121:Burkholderia Infections / Q000188:drug therapy* / Q000209:etiology*; D016956:Burkholderia cepacia; D002701:Chloramphenicol / Q000009:adverse effects* / Q000627:therapeutic use; D003550:Cystic Fibrosis / Q000150:complications*; D005260:Female; D005838:Genotype; D006801:Humans; D012313:RNA / Q000037:antagonists & inhibitors; D000077278:RNA, Mitochondrial
chemical_list: D000077278:RNA, Mitochondrial; D012313:RNA; D002701:Chloramphenicol
keywords: chloramphenicol; cystic fibrosis; lactic acidosis; mitochondria; multi-resistant bacterial infection