Metformin İlişkili Laktik Asidoz; Bir Olgu Nedeni ile Literatürün Gözden Geçirilmesi

Abstract

Öz Metformin biguanid sınıfından, Tip 2 diyabetiklerde, özellikle böbrek fonksiyonları normal hastalarda ilk basamakta kullanılan oral antidiyabetiktir. Metforminin en ciddi ve ölümcül yan etkisi laktik asidozdur. Böbrek yetersizliği laktat atılım bozukluğunun en sık sebebidir. Acil serviste, suisid amaçlı ilaç alımından sonra yüksek anyon açıklı metabolik asidoz varlığı olan hastalarda metformin intoksikasyonu düşünülmelidir. 44 yaşında kadın hasta intihar amaçlı 50 gram metformin alımından 3 saat sonra acil servise bulantı ve karında şişkinlik şikâyeti ile başvurdu. Hastada metformin ilişkili laktik asidoz (pH<7.35, laktat düzeyi>5 mmol/L ve bikarbonat<22 mmol/L) tanımlandı. Erken tanı ve hemodiyaliz veya hemofiltrasyon yöntemleri ile metabolik asidozun hızlı düzeltilmesi, destek tedavisi ve kan glikoz düzeyinin ayarlanması pozitif sonuçlara neden olacaktır.

A Case Report of Metformin Related Lactic Acidosis

“…Metformin is a drug from the biguanide groupu sed in the treatment of type 2 diabetes mellitus (2). In high dose metformin intake, nonspecific symptoms including anorexia, lethargy, nausea, vomiting and epigastric pain as well as life-threatening symptoms including moderate renal failure, hypotension, hypothermia, respiratory failure and cardiac rhythm disturbances may develop (2,3,4,7).…”

“…In patients with an estimated GFR <30 mL/min/1.73 m2, drug use should be stopped. The oretically, impaired renal function decreases GFR and this increases metformin accumulation in the body (2,3,4). In this case, a patient hospitalized in the internal medicine clinic because of lactic acidosis due to metformin intoxication was successfully treated with early diagnosis.…”

“…According to the first report of Turkish National Poison Control Center on the application by poisoning in Turkey is located medical drugs (69.74%) (1). Metformin is a biguanide group insulin-sensitizing drug used in the treatment of type 2 Diabetes Mellitus (DM) (2). Metformin exertsits effect by decreasing hepatic glucose production and gastrointestinal glucose absorption and increasing peripheral glucose utilization (2,3,4).…”

“…Metformin is a biguanide group insulin-sensitizing drug used in the treatment of type 2 Diabetes Mellitus (DM) (2). Metformin exertsits effect by decreasing hepatic glucose production and gastrointestinal glucose absorption and increasing peripheral glucose utilization (2,3,4). The blood glucose lowering effect of metformin is largely due to the 25-30% decrease in endogenous glucose production.…”

“…Unlike sulfonylurea group oral antidiabetics, it does not stimulate insulin release. It is excreted from the body through the kidney and may accumulate in the body due to decreased clearance in cases of renal failure (2,3,4,5,6). Side effects of metformin usually include gastrointestinal complaints such as nausea, anorexia, diarrhea, abdominal cramps and hypothermia (2,4,6).…”