Linezolid-Associated Lactic Acidosis Requiring Intermittent Hemodialysis and Continuous Renal Replacement Therapy: A Case Report
Bibliographic record
Abstract
Introduction: Linezolid, an oxazolidinone antibiotic used for multidrug-resistant gram-positive infections and drug-resistant tuberculosis, has been associated with rare but potentially fatal lactic acidosis due to mitochondrial toxicity. Kidney replacement therapy (KRT) has been utilized for lactate clearance and linezolid elimination, although its role and utility remain incompletely defined. Case Description: We report a case of a 75-year-old male with history of pulmonary tuberculosis on prolonged linezolid therapy who developed severe type B lactic acidosis (lactate 20.0 mmol/L) without hemodynamic instability. Following initial correction with two sessions of intermittent hemodialysis (IHD), rebound lactate elevation necessitated transition to continuous renal replacement therapy (CRRT). Sustained lactate clearance and metabolic stabilization were achieved after 30.8 hours of CRRT, without requiring vasopressors or additional organ support. Infectious and ischemic causes were excluded. Discussion: This case highlights a unique sequential KRT approach in the management of linezolid-induced lactic acidosis in a hemodynamically stable patient. Despite partial dialyzability of linezolid, lactate rebound following IHD suggests ongoing mitochondrial dysfunction and redistribution of lactate given its high volume of distribution, necessitating prolonged clearance through CRRT. Our findings emphasize the importance of early recognition of toxicity and tailored KRT strategies based on clinical trajectory rather than hemodynamic status alone.Laboratory data from hospitalization days 1-6. Numbers in parentheses indicate hours since KRT initiation.Lactate over time following IHD and CRRT.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.007 | 0.005 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".