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ISSN: 1734-1922
Archives of Medical Science
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vol. 16
Clinical pharmacology
Letter to the Editor

Blood lactic acid increased by hydroxyurea in a leukemia patient

Jing Hu
Can Luo

Department of Pharmacy, First Affiliated Hospital of Nanjing Medical, Nanjing, China
Arch Med Sci 2020; 16 (6): 1487–1490
Online publish date: 2019/07/11
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Lactic acidosis or hyperlactatemia is a common symptom in patients with sepsis or hypovolemia. The generation of lactate needs pyruvic acid that is catalyzed by lactate dehydrogenase (LDH) in the cytosol. With sufficient oxygen supply, pyruvic acid from glucose can be transported into mitochondria and completely decomposed. As a result, anaerobic glycolysis of glucose is increased and more lactic acid is produced at low oxygen levels, which is known as hypoxia. Correspondingly, hyperlactatemia occurs when the balance between generation and conversion is broken. The higher the lactate level is, the worse is the outcome [1]. Hyperlactatemia in patients in the intensive care unit (ICU) is mainly related to hypoperfusion and hypoxia, although other causes including some usual drugs and hematological malignancies may also cause hyperlactatemia. Despite increasing public awareness and advanced detection methods in place, drug-induced lactic acidosis is often overlooked. The treatment of hyperlactatemia is dependent on the cause. The wrong treatment will not only delay the treatment or even cause death, but also increase the additional economic burden. So understanding pharmacological factors of hydroxyurea causing hyperlactatemia in the condition could lead to avoiding the wrong treatment. We report a case of an elderly man who falsely presented with elevated blood lactic acid due to treatment with hydroxyurea.
A 62-year-old male patient was hospitalized because of coughing, expectoration, shortness of breath and large ecchymosis in the skin for 1 week. His past history and medication history had no abnormalities. At admission, the main haematological parameters from peripheral blood showed thrombocytopenia and erythropenia. The main haematological parameters were as follows: hemoglobin 46 g/l, platelet count 15 × 109/l, leucocyte count 22.74 × 109/l (neutrophils 4%, lymphocytes 13%, monocytes 13%) and immature cells accounting for 70%. A bone marrow puncture was performed and the patient was finally diagnosed with acute myeloid leukemia (AML, M3). Consequently, leukemia control treatment ((hydroxyurea (1 g, three times a day), retinoic acid (10 mg, twice a day) and prednisone (10 mg, three times a day)) was started at the first day of admission on July 31 and August 1. However, the patient was admitted to our intensive care unit for severe pneumonia. Leukemia control treatment (hydroxyurea 1 g three times a day, retinoic acid 10 mg twice a day and...

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