Statin precipitated lactic acidosis?

Area of Science:

• Biochemistry
• Internal Medicine
• Medical Genetics

Background:

• Metabolic acidosis is a critical condition often associated with elevated lactate levels.
• Identifying the underlying cause of lactic acidosis is crucial for effective treatment.

Observation:

• An 82-year-old female presented with dyspnea and was diagnosed with compensated metabolic acidosis and hyperventilation-induced hypocapnia.
• Laboratory results revealed an increased anion gap and elevated lactate levels, consistent with lactic acidosis.

Findings:

• The patient's lactic acidosis resolved after the discontinuation of Atorvastatin, suggesting a link to statin therapy.
• Subsequent thiamine deficiency was identified.
• The acidosis was attributed to a mitochondrial defect caused by deficiencies in ubiquinone (statin-related) and thiamine (dietary).

Implications:

• This case highlights a potential drug-induced mitochondrial dysfunction, specifically statin-induced ubiquinone deficiency, as a cause of lactic acidosis.
• It underscores the importance of considering cofactor deficiencies, including thiamine, in patients with unexplained metabolic acidosis.
• This finding may prompt further investigation into the role of statins in mitochondrial health and the management of metabolic acidosis.