Bicarbonate haemodialysis as a treatment of metformin overdose

Heaney, D. P.; Majid, Alyaa; Junor, B. J. R.

doi:10.1093/ndt/12.5.1046

Cited by 93 publications

(83 citation statements)

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“…Hypotension, hypothermia, cardiac dysrhythmias, and respiratory failure may also occur in severe metformin-associated lactic acidosis. [73][74][75] Blood glucose levels may be low, normal, or high in diabetic subjects and lactic acidosis may also accompany ketoacidosis.…”

Section: Presentationmentioning

confidence: 99%

Hyperglycaemic crises and lactic acidosis in diabetes mellitus

English

Williams

2004

Postgraduate Medical Journal

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Diabetic ketoacidosis, hyperglycaemic hyperosmolar state, and lactic acidosis represent three of the most serious acute complications of diabetes. There have been some advances in our understanding of the pathogenesis of these conditions over the last three decades, together with more uniform agreement on their treatment and innovations in technology. Accordingly their incidence, morbidity, and mortality are decreasing, but at rates that fall short of our aspirations. Hyperglycaemic crises in particular remain an important cause of morbidity and mortality in diabetic populations around the world. In this article, understanding of these conditions and advances in their management, and the available guidelines for their treatment, are reviewed. As far as is possible, the recommendations are based on clear published evidence; failing that, what is considered to be a common sense synthesis of consensus guidelines and recommendations is provided.

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Section: Presentationmentioning

confidence: 99%

Hyperglycaemic crises and lactic acidosis in diabetes mellitus

English

Williams

2004

Postgraduate Medical Journal

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“…MALA is effectively treated by withdrawing metformin and haemodialysis which removes metformin from the circulation [23][24][25][26]. Therapeutic benefits of dichloroacetate, trihydroxy methyl aminomethane [26], as well as intravenous infusions of methylene blue [8] have been described in some cases.…”

Section: Discussionmentioning

confidence: 99%

Lactic Acidosis in a Man with Diabetes: Is Metformin the Culprit?

Dissanayake¹,

Wijewickrama²,

Katulanda³

2017

J Diabetes Metab

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Background: Lactic acidosis is a rare but serious adverse effect of metformin, particularly when used in high doses in patient with other risk factors. We report a case of metformin associated lactic acidosis that improved with hemodialysis.Case presentation: Seventy-year-old male with diabetes and stage IV chronic kidney disease presented with vomiting and was found to have lactic acidosis with lactate of 8 mmol/L while being on metformin 1 g thrice daily. He was successfully managed with haemodialysis and supportive care. Conclusion:This case illustrates the importance of judicious drug prescription in patients with multiple comorbidities; need to consider metformin induced lactic acidosis in appropriate settings and importance of active management with haemodialysis. Recommendations on prevention and options for treatment are also be discussed.

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“…El mejor tratamiento para estos pacientes son el bicarbonato y la hemodiálisis, con los que se puede corregir la acidosis y eliminar la metformina 6,7 . En este caso destaca que la paciente previamente tenía función renal normal y en contexto de una sepsis con deshidratación secundaria a diarrea infecciosa, rápidamente desarrolló esta complicación grave y de alta letalidad.…”

Section: Discussionunclassified

Acidosis láctica asociada a metformina. Caso clínico

et al. 2017

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Metformin-associated lactic acidosis isL a metformina es un agente hipoglicemiante de la familia de las biguanidas que promueve la euglicemia al disminuir la insulino-resistencia, la producción hepática de glucosa y la absorción intestinal de ésta. La acidosis láctica asociada a metformina es una complicación poco frecuente, pero que siempre se debe tener presente a la hora de enfrentar a pacientes que estén cursando con acidosis láctica no asociada a causas evidentes de hipoperfusión tisular. Debe considerarse dada alta prevalencia de DM-2 en nuestra población y requiere de una interrogación dirigida en la anamnesis de cada paciente. Su alta mortalidad, que incluso puede llegar a ser 50-80%, y la existencia de un tratamiento específico y efectivo 1 , son factores que nos obligan a tener una alta sospecha clínica. En este reporte se presenta el caso de una paciente y revisión de la patología. Caso clínicoSe trata de una paciente femenina de 56 años, con antecedentes de tabaquismo activo, diabetes mellitus tipo 2 no insulino requiriente (DM2 NIR) e hipertensión arterial (HTA), en tratamiento con losartán 50 mg al día, aspirina 100 mg al día, linagliptina/metformina 2,5/1.000 al día y glibenclamida 5 mg cada 12 h. Acudió al servicio de urgencia por cuadro de 2 días de evolución caracterizado por compromiso del estado general, mialgias generalizadas y disminución del apetito sin descontinuar consumo de fármacos habituales. Un día antes del ingreso se agregaron náuseas, vómitos, que fueron manejadas parcialmente con ondansetrón, y diarrea profusa sin elementos patológicos, asociado a glicemia capilar de 50 mg/dl. Al llegar al servicio de urgencia, se controló nueva glicemia capilar que resultó en 46 mg/dL (VN 70 -100 mg/dl), por lo que se inició manejo con 2 ampollas de solución glucosada al 30% y posteriormente suero glucosado al 10% en infusión continua. Al examen físico de ingreso destacaba lúcida, sin signos clínicos de hipoperfusión, y con importante dolor abdominal difuso en los 4 cuadrantes, sin clínica de irritación peritoneal. Se realizó ecografía de abdomen que no evidenció lesión intra-abdominal que explicara el cuadro

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Bicarbonate haemodialysis as a treatment of metformin overdose

Abstract: Initial treatment included 100 ml 50% glucose i.v., oxygen at 10 l/min and when his conscious level toxicity improved, a gastric lavage. His conscious level returned to 15/15 on the GCS. Blood glucose was measured at 18 mmol/l.

Cited by 93 publications

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Hyperglycaemic crises and lactic acidosis in diabetes mellitus

Hyperglycaemic crises and lactic acidosis in diabetes mellitus

Lactic Acidosis in a Man with Diabetes: Is Metformin the Culprit?

Acidosis láctica asociada a metformina. Caso clínico

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