lactic acidosis and fatty liver


Dear Doctor: Could you tell me the clinical manifestations of lactic acidosis/steatosis(fatty liver)caused by d4T/ddI? Nausea and diarrhea are the symptoms of that?


Lactic acidosis/hepatic steatosis is often relatively asymptomatic initially. There may be some complaints of abdominal fullness with an enlarged liver on exam. BLood tests may show some liver enzyme abnormalities and a mild-moderate elevation of the venous lactic acid level. More advanced stage of the syndrome may have non-specific GI complaints like nausea/vomiting/fullness/bloating/malaise. Those symptoms are non-specific so good evaluation is necessary to sort out. Those problems are not solely associated with d4T/ddI but with many of the nucleoside agents as well as other drugs and conditions. Keith Henry, M.D.