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Severe Lactic Acidosis Due to Acute Intoxication by Emtricitabine/Tenofovir Alafenamide

A 46-year-old female with a history of generalized anxiety disorder was admitted after intentional ingestion of an unknown amount of emtricitabine/tenofovir alafenamide (Descovy®) in a suicidal attempt. Patient was emergently intubated secondary to severe agitation and inability to protect airways....

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Autores principales: Chaparala, Swethapriya, Da Silva, Rafael C, Papadopoulos, John Paul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8610206/
https://www.ncbi.nlm.nih.gov/pubmed/34824925
http://dx.doi.org/10.7759/cureus.19008
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author Chaparala, Swethapriya
Da Silva, Rafael C
Papadopoulos, John Paul
author_facet Chaparala, Swethapriya
Da Silva, Rafael C
Papadopoulos, John Paul
author_sort Chaparala, Swethapriya
collection PubMed
description A 46-year-old female with a history of generalized anxiety disorder was admitted after intentional ingestion of an unknown amount of emtricitabine/tenofovir alafenamide (Descovy®) in a suicidal attempt. Patient was emergently intubated secondary to severe agitation and inability to protect airways. Patient developed severe lactic acidosis early in the admission, secondary as to a possible mitochondrial toxicity. Failed attempts to fluid resuscitation with Lactate Ringer®, eventually warranted to start the patient on norepinephrine infusion. Metabolic acidosis remained refractory to bicarbonate bolus and infusion. Hypothermia and hypoglycemia were corrected. Despite the initial approach, the patient remained acidotic, and the nephrology was consulted for emergent continuous renal replacement therapy (CRRT). After three days of intensive care unit stay and CRRT, the patient improved and was successfully decannulated. Her metabolic profile also showed remarkable improvement and the metabolic lactic acidosis resolved. The previous formulation of tenofovir with disoproxil fumarate is associated with severe lactic acidosis due to inhibition of mammalian mitochondrial DNA polymerase. Risk factors include liver cirrhosis, chronic kidney disease, hepatitis B and C coinfection, and metformin use. The new pharmaceutical formulation of tenofovir with alafenamide (TAF) has caused a significant decrease in the incidence of lactic acidosis. However, its real incidence and the usual plasma level to induce toxicity and mitochondrial dysfunction are unknown. The aim of this report is to highlight the risk of severe lactic acidosis with the use of TAF.
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spelling pubmed-86102062021-11-24 Severe Lactic Acidosis Due to Acute Intoxication by Emtricitabine/Tenofovir Alafenamide Chaparala, Swethapriya Da Silva, Rafael C Papadopoulos, John Paul Cureus Emergency Medicine A 46-year-old female with a history of generalized anxiety disorder was admitted after intentional ingestion of an unknown amount of emtricitabine/tenofovir alafenamide (Descovy®) in a suicidal attempt. Patient was emergently intubated secondary to severe agitation and inability to protect airways. Patient developed severe lactic acidosis early in the admission, secondary as to a possible mitochondrial toxicity. Failed attempts to fluid resuscitation with Lactate Ringer®, eventually warranted to start the patient on norepinephrine infusion. Metabolic acidosis remained refractory to bicarbonate bolus and infusion. Hypothermia and hypoglycemia were corrected. Despite the initial approach, the patient remained acidotic, and the nephrology was consulted for emergent continuous renal replacement therapy (CRRT). After three days of intensive care unit stay and CRRT, the patient improved and was successfully decannulated. Her metabolic profile also showed remarkable improvement and the metabolic lactic acidosis resolved. The previous formulation of tenofovir with disoproxil fumarate is associated with severe lactic acidosis due to inhibition of mammalian mitochondrial DNA polymerase. Risk factors include liver cirrhosis, chronic kidney disease, hepatitis B and C coinfection, and metformin use. The new pharmaceutical formulation of tenofovir with alafenamide (TAF) has caused a significant decrease in the incidence of lactic acidosis. However, its real incidence and the usual plasma level to induce toxicity and mitochondrial dysfunction are unknown. The aim of this report is to highlight the risk of severe lactic acidosis with the use of TAF. Cureus 2021-10-24 /pmc/articles/PMC8610206/ /pubmed/34824925 http://dx.doi.org/10.7759/cureus.19008 Text en Copyright © 2021, Chaparala et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Emergency Medicine
Chaparala, Swethapriya
Da Silva, Rafael C
Papadopoulos, John Paul
Severe Lactic Acidosis Due to Acute Intoxication by Emtricitabine/Tenofovir Alafenamide
title Severe Lactic Acidosis Due to Acute Intoxication by Emtricitabine/Tenofovir Alafenamide
title_full Severe Lactic Acidosis Due to Acute Intoxication by Emtricitabine/Tenofovir Alafenamide
title_fullStr Severe Lactic Acidosis Due to Acute Intoxication by Emtricitabine/Tenofovir Alafenamide
title_full_unstemmed Severe Lactic Acidosis Due to Acute Intoxication by Emtricitabine/Tenofovir Alafenamide
title_short Severe Lactic Acidosis Due to Acute Intoxication by Emtricitabine/Tenofovir Alafenamide
title_sort severe lactic acidosis due to acute intoxication by emtricitabine/tenofovir alafenamide
topic Emergency Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8610206/
https://www.ncbi.nlm.nih.gov/pubmed/34824925
http://dx.doi.org/10.7759/cureus.19008
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