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NDT Advance Access published online on November 22, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl671
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
(Section Editor: M. G. Zeier)

Hyperpnoea and ketonuria in an HIV-infected patient

C. Roubaud-Baudron1, Edward Bourry1, Valerie Martinez2, Ana Canestri2, Gilbert Deray1 and Hassane Izzedine1

1Department of Nephrology
2Department of Infectious Diseases
Pitie-Salpetriere Hospital
Paris
France

Correspondence and offprint requests to: Correspondence and offprint requests to: Dr Hassane Izzedine, Department of Nephrology, La Pitié-Salpêtrière Hospital, 47-80 Bonlevard de I'Hôpital, Assistance Publique-Hopitaux de Paris, Pierre et Marie Curie University, 75013 Paris, France. Email: hassan.izzedine@psl.aphp.fr

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A 32-year-old HIV-infected man of African origin presented to our emergency department with a 3-day history of nausea, vomiting, abdominal pain and muscular pain. The patient was alert and oriented. He denied alcohol, tobacco and illicit drug use. His current medications were lopinavir, Epivir, stavudine and trimethoprim-sulfamethoxazole.

In the emergency room, he was afebrile; blood pressure 110/70 mmHg and pulse rate was at 110/min. Kussmaul breathing at a frequency of 32 breaths/min was noted. The patient's pulse oximetry revealed a saturation of 99% on room air, and capillary blood sugar was 150 mg/dl. Electrocardiogram showed normal sinus rhythm. The patient had lost 5 kg in weight . . . [Full Text of this Article]



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First hypothesis: primary respiratory alkalosis with compensatory decrease of bicarbonate and elevated lactates
Second hypothesis: primary lactic acid acidosis (complicating NRTIs therapy) with compensatory decrease in respiratory CO2 tension
Third hypothesis: the acid–base disturbances in this case represent a mixed disorder of metabolic acidosis and respiratory alkalosis

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