CRITICAL CARE ISSUES FOR THE NEPHROLOGIST: Acid–base Disturbances in the Intensive Care Unit: Metabolic Acidosis

Schoolwerth, Anton C.; Kaneko, Thomas M.; Sedlacek, Martin; Block, Clay A.; Remillard, Brian D.

doi:10.1111/j.1525-139x.2006.00211.x

Cited by 12 publications

(13 citation statements)

References 25 publications

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“…We could speculate that the rapid correction of acidosis was not associated with total clearance of metformin from intracellular compartment and toxicity still exerts its effect in endomembrane system and proteins, resulting in late cell death. [21][22][23]. It is still unclear why some patients recover from severe MALA while others invariably die.…”

Section: Discussionmentioning

confidence: 99%

Severe Metformin Associated Lactic Acidosis: A Case Series Of An Intensive Care Unit

et al. 2015

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Background: Severe metformin-associated lactic acidosis (MALA) is a rare but potentially fatal side effect of metformin. The clinical presentation is often unspecific, thus hindering early recognition. We aimed to assess the prevalence of MALA in an intensive care unit (ICU) and describe the demographic and clinical characteristics according to patient outcome. Methods:We conducted a 13-year single-center retrospective study, including all patients admitted in ICU with a high anion-gap metabolic acidosis and hyperlactatemia secondary to therapeutic use of metformin, after excluding other medical causes of acidosis.Results: Twenty one patients were admitted in ICU due to severe MALA (less than 1% of all admissions) with an ICU mortality rate of 23.8% (N=5). The baseline clinical characteristics were similar in survivors and nonsurvivors, both with a high prevalence of cardiovascular comorbidities as well as frequent concomitant therapy with angiotensin-converting-enzyme inhibitors and diuretics. All patients were treated with continuous renal replacement therapy (CRRT) and other organ failure support. Normal acid-base balance was achieved in all survivors in the first 24 hours. At baseline, the clinical and laboratory features of nonsurvivors were undistinguishable from survivors. Conclusions:Severe MALA is a rare cause of admission in the ICU.Although early institution of supportive therapy, MALA can progress to severe multiple-organ failure, especially when diagnosis and CRRT are delayed. Clinicians should suspect of MALA in all diabetic patients taking metformin with unexplained high anion-gap metabolic acidosis and hyperlactatemia.

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Section: Discussionmentioning

confidence: 99%

Severe Metformin Associated Lactic Acidosis: A Case Series Of An Intensive Care Unit

et al. 2015

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“…Presumed metabolic acidosis is usually evidenced by progressive deterioration and refractory response to interventions during resuscitation. [29][30][31][32] Furthermore, the premature newborn literature associates metabolic acidosis with causing intraventricular or periventricular bleeding and long-term neurodevelopmental deficiencies involving hearing, vision, and cognitive ability, as well as increased mortality. Confirmed metabolic acidosis is determined by serum analysis of decreased bicarbonate levels, ,20 mEq/liter, with increased H 1 concentration indicated by a serum pH ,7.1, as well as the other blood gas parameters.…”

Section: Presumptive Clinical Indications For Bicarbonatementioning

confidence: 99%

Sodium Bicarbonate Use in the Treatment of Acute Neonatal Lactic Acidosis

Johnson¹

2011

Neonatal Network

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“…Assim sendo, a administração de bicarbonato de sódio (BS) interromperia os distúrbios metabólicos associados à acidemia, promovendo benefícios superiores aos seus efeitos adversos. Entretanto, vários relatos e discussões revelam que o bicarbonato falharia em elevar o pH plasmático em certas situações, além de promover acidose intracelular, entre outros efeitos indesejáveis [1][2][3][4][5] .…”

Section: Introductionunclassified

Metabolic acidosis in childhood: why, when and how to treat

Andrade¹,

Ihara

Troster

2007

J Pediatr (Rio J)

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Objectives: To critically discuss the treatment of metabolic acidosis and the main mechanisms of disease associated with this disorder; and to describe controversial aspects related to the risks and benefits of using sodium bicarbonate and other therapies. Other promising treatment alternatives have been proposed; however, the side effects and absence of controlled studies with pediatric populations translate into lack of evidence to support the routine use of such treatments.J Pediatr (Rio J). 2007;83(2 Suppl):S11-21: Acidosis/therapy, acidosis, lactic, diabetic ketoacidosis, sodium bicarbonate, child.

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CRITICAL CARE ISSUES FOR THE NEPHROLOGIST: Acid–base Disturbances in the Intensive Care Unit: Metabolic Acidosis

Abstract: This article will discuss metabolic acidosis and, to a lesser extent, metabolic alkalosis in the ICU setting. A classification and clinical approach will be the focus.

Cited by 12 publications

References 25 publications

Severe Metformin Associated Lactic Acidosis: A Case Series Of An Intensive Care Unit

Severe Metformin Associated Lactic Acidosis: A Case Series Of An Intensive Care Unit

Sodium Bicarbonate Use in the Treatment of Acute Neonatal Lactic Acidosis

Metabolic acidosis in childhood: why, when and how to treat

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