scholarly journals Metformin-Associated Lactic Acidosis following Intentional Overdose Successfully Treated with Tris-Hydroxymethyl Aminomethane and Renal Replacement Therapy

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Ngan Lam ◽  
Gurbir Sekhon ◽  
Andrew A. House
Keyword(s):  
Metabolic Acidosis ◽  
Renal Replacement Therapy ◽  
Lactic Acidosis ◽  
Serum Creatinine ◽  
Replacement Therapy ◽  
Delayed Diagnosis ◽  
Complete Recovery ◽  
Nondiabetic Patient ◽  
Severe Metabolic Acidosis ◽  
Metformin Concentration

A 43-year-old woman was brought to the hospital with severe metabolic acidosis (pH 6.56, bicarbonate 3 mmol/L, and lactate 18.4 mmol/L) and a serum creatinine of 162 μmol/L with a serum potassium of 7.8 mmol/L. A delayed diagnosis of metformin-associated lactic acidosis was made, and she was treated with tris-hydroxymethyl aminomethane (THAM) and renal replacement therapy (RRT). Following a complete recovery, she admitted to ingesting 180 tablets (90 grams) of metformin. Her peak serum metformin concentration was 170 μg/mL (therapeutic range 1-2 μg/mL). Our case demonstrates an intentional metformin overdose resulting in lactic acidosis in a nondiabetic patient who was successfully treated with THAM and RRT.

Survival and complete recovery after severe acute ethylen glycol poisoning — a case report

Open Medicine ◽  
2011 ◽  
Vol 6 (6) ◽  
pp. 813-817
Author(s):  
Andreja Sinkovic ◽  
Rok Stopar
Keyword(s):  
Metabolic Acidosis ◽  
Renal Replacement Therapy ◽  
Renal Dysfunction ◽  
Replacement Therapy ◽  
Early Recognition ◽  
Complete Recovery ◽  
Anion Gap ◽  
Unknown Quantity ◽  
Bicarbonate Therapy ◽  
Late Start

AbstractEarly signs of acute ethylene glycol (EG) poisoning are similar to ethanol intoxication. However, such signs of EG poisoning are followed by severe metabolic acidosis, increased anion gap, neurological and renal dysfunction, and, without adequate therapy, up to 40% mortality. Early recognition and treatment with intravenous ethanol or fomepizole and bicarbonate, renal replacement therapy, and supportive measures are the key elements of survival.We report a patient presenting in a coma with a metabolic acidosis on admission of pH 6.89, an increased anion gap of 29 mmol/L, and acute renal failure after the ingestion of an unknown quantity of EG. Intravenous bicarbonate and fluids and other supportive measures such as intubation, mechanical ventilation and vasopressors were started immediately. EG poisoning was confirmed by the finding of EG in the urine by gas chromatography. Intravenous ethanol and renal replacement therapy were started. The duration of ethanol infusion was guided by the serum pH and anion gap. After a long in-hospital stay, the patient survived with complete neurological recovery but mild renal dysfunction, confirming that, despite the late start of agressive intensive treatments, survival, and even nearly complete recovery, is possible in cases of severe EG poisoning. In addition, the case suggests that serial pH measurements are satisfactory guides for the duration of intravenous ethanol and bicarbonate therapy.

scholarly journals P0600LONG-TERM PROGNOSIS OF PATIENTS WITH METFORMIN -ASSOCIATED LACTIC ACIDOSIS(MALA) AND ACUTE KIDNEY FAILURE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Maria Rosa Melero Martin ◽  
Alejandra Muñoz de Morales ◽  
Alberto Tejedor Jorge ◽  
Rodriguez benitez Patrocinio ◽  
Arturo Bascuñana ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Replacement Therapy ◽  
Lactic Acidosis ◽  
Serum Creatinine ◽  
Replacement Therapy ◽  
Rare Event ◽  
Case Series ◽  
Renal Outcomes ◽  
Iodinated Contrast

Abstract Background and Aims Although metformin-associated lactic acidosis (MALA) is a very rare event, is frequently seen in patients on metformin with risk factors for developing acute kidney injury (AKI). The long-term prognosis in patients with metformin-associated lactic acidosis (MALA) and renal failure remains unknown. To describe the characteristics and prognosis of AKI in patients with MALA and investigate whether prescription of RRT and previous renal function are associated with long-term outcomes. Method A retrospective single-centre case series. One hundred and nine patients affected with MALA and AKI admitted between Marx 2007 and February 2019 were included. We analysed comorbidities, laboratory tests, clinical parameters and prescription pattern of RRT at admission. After discharging, renal outcomes (doubling serum creatinine or starting dialysis) and mortality were assessed in the long-term. Results We included 109 patients (59 males and 50 females), mean age of 74.2±8.6 years and mean Charlson comorbidity index of 8.0±2.4. 54 out of 109 patients had previous chronic kidney disease (eGFR < 60 ml/min/1.72 m2). Precipitating causes of AKI associated MALA included; acute dehydration (84.4%), exposure to iodinated contrast (7.3%) and non-specified causes (8.3%). During the admission, renal replacement therapy (RRT) was performed in 72 patients (continuous renal replacement therapy in 47 and dialysis in 25). RRT requirements was significantly associated with lactate, acidosis and serum creatinine levels, but not was associated with higher mortality rate during admission. The patients were followed a median time of 33 (10-65) months after discharging. 33 patients had a renal event and 55 patients died. The patients with CKD before admission had higher number of renal events (log Rank 6.346, p=0.012) and higher mortality (log Rank 12.943, p<0.001). In a model adjusted by age and RRT at admission, women were less likely to develop (HR 0.315(0.136-0.730, p=0.007) long-term renal events and previous CKD increased this probability (HR 2,532 (1.190-5.385), p=0.016). Previous CKD and RRT during admission increased mortality in a model adjusted by age, gender and comorbidity (HR 2.315(1.177-4.553), p=0.015 and HR 1.895(1.003-3.580), p=0.049, respectively). Conclusion The renal function prior to the episode of AKI associated to MALA and the RRT at admission are the main factors related to renal outcomes and mortality in the long-term.

scholarly journals Metformin-Associated Lactic Acidosis Undergoing Renal Replacement Therapy in Intensive Care Units: A Five-Million Population-Based Study in the North-West of Italy

2017 ◽  
Vol 44 (3) ◽  
pp. 198-205 ◽  
Author(s):  
Filippo Mariano ◽  
Marco Pozzato ◽  
Paola Inguaggiato ◽  
Cesare Guarena ◽  
Ernesto Turello ◽  
...  
Keyword(s):  
Intensive Care ◽  
Survival Rate ◽  
Renal Replacement Therapy ◽  
Lactic Acidosis ◽  
Replacement Therapy ◽  
Intensive Care Units ◽  
High Efficiency ◽  
Journal Club ◽  
Large Population ◽  
High Survival

Background: Metformin-associated lactic acidosis (MALA) is a severe complication of drug administration with significant morbidity and mortality. So far no study in large population areas have examined the incidence, clinical profile and outcome of acute kidney injury (AKI)-MALA patients admitted in intensive care units (ICUs) and treated by renal replacement therapy (MALA-RRT). Methods: Retrospective analysis over a 6-year period (2010-2015) in Piedmont and Aosta Valley regions (5,305,940 inhabitants, 141,174 diabetics treated with metformin) of all MALA-RRT cases. Results: One hundred and seventeen cases of AKI-MALA-RRT were observed (12.04/100,000 metformin treated diabetics, 1.45% of all RRT-ICU patients). Survival rate was 78.3%. The average duration of RRT was 4.0 days at mean dialysis effluent of 977 mL/kg/day. At admission most patients were dehydrated, and experienced shock and oliguria. Conclusion: Our data showed that MALA-RRT is a common complication, needing more prevention. Adopted policy of early, extended, continuous and high efficiency dialysis could contribute to an observed high survival rate. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=471917.

Metformin Associated Lactic Acidosis in Clinical Practice – A Case Series

2020 ◽  
Author(s):  
Philipp Schädle ◽  
Otto Tschritter ◽  
Monika Kellerer
Keyword(s):  
Renal Replacement Therapy ◽  
High Risk ◽  
Lactic Acidosis ◽  
Replacement Therapy ◽  
Risk Score ◽  
Risk Group ◽  
Case Series ◽  
Individual Risk ◽  
Volume Depletion ◽  
Screening Criteria

Abstract Aims The aim of this case report is to specify the frequency and mortality of Metformin-Associated Lactic Acidosis (MALA) in emergency medicine, as the diagnosis seems to occur more often than estimated. Methods To identify the subjects, we developed screening criteria for MALA. We measured the serum metformin concentration to confirm the diagnosis in all patients fulfilling these criteria. Retrospectively the patients were grouped according to individual risk (according to a defined risk score) and the application of renal replacement therapy. Results From 2013 until 2018 we were able to identify 11 MALA patients revealing a frequency of 1:4,000 emergency patients. Six patients survived and five died in the follow-up. All three patients in the high-risk group died although all of them received renal replacement therapy. In the low-risk group (three patients, one with renal replacement therapy), all patients survived, while in the intermediate-risk group (five patients, one with renal replacement therapy) three patients survived and two died. Additional severe comorbidities also contributed to mortality. Conclusions Every patient matching the screening criteria of acute renal failure, lactic acidosis and continued intake of metformin can be considered a potential MALA case. A risk score assessment which includes severe comorbidities may help to identify high-risk individuals and should be evaluated in larger studies.To prevent MALA, patients should be trained to immediately interrupt their own metformin use when showing signs of volume depletion. Physicians should be aware of the additional risk factors such as co-medication with diuretics, ACE (angiotensin converting enzyme) ACE inhibitors and NSAIDs (non steroidal anti inflammatory drugs).

Dialytic Support in Patients with Acute Renal Failure with Implantable Left Ventricular Assist Devices

1997 ◽  
Vol 12 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Luz Moreno ◽  
Martine Leblanc ◽  
Melisa Gurley ◽  
Patrick Mccarthy ◽  
Emil P. Paganini
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Serum Creatinine ◽  
Heart Transplantation ◽  
Replacement Therapy ◽  
Metabolic Control ◽  
Left Ventricular ◽  
Ventricular Assist ◽  
Left Ventricular Assist

The left ventricular assist device (LVAD), used thus far as a bridge to heart transplantation, may offer an alternative to heart transplantation. Because patients receiving LVADs are in cardiogenic shock, many experience acute ischemic renal failure in the peri-implantation period. We describe 10 patients who underwent dialysis after receiving LVADs for end-stage heart disease. Among 37 patients who received an LVAD, 10 required dialytic support (8 men, 2 women; mean age, 47.3 ± 11.3 yr; mean APACHE II score at ICU admission, 18.0 ± 4.7). Renal replacement therapy was started for fluid removal within 48 hours of LVAD implantation in 8 patients. Continuous renal replacement therapy (CRRT) was the first-line modality for 9 patients, including 3 slow continuous ultrafiltrations (SCUF), 4 continuous venovenous hemofiltrations (CWH), 5 continuous venovenous hemodiafiltrations (CWHD), 2 continuous arteriovenous hemofiltrations (CAVH), and 1 continuous arteriovenous hemodiafiltration (CAVHD). Patients remained on CRRT for a mean of 14.4 ± 6.1 days, and 5 were eventually changed to intermittent hemodialysis. The mean time on renal replacement therapy was 27.8 ± 19.7 days. During CRRT, despite daily average ultrafiltration of 3,445 ± 623 mL, net fluid loss was only 358 ± 507 mL/day. Metabolic control achieved with CRRT, expressed as mean ± SD, was: BUN 75.5 ± 13.0 mg/dL (26.9 ± mmol/L), serum creatinine 4.0 ± 0.7 mg/dL (354 ± 62 mmol/L), carbon dioxide content (bicarbonate plus dissolved CO2) 21.5 ± 1.7 mEq/L, and serum electrolytes within normal limits. Survival for patients with LVADs who did not require dialysis was 93% compared with 40% for the group with combined LVADs and dialytic support. The 4 patients who survived in the dialysis group all recovered renal function, and their need for dialysis ceased within 18 to 33 days. Mean serum creatinine levels at follow-up after transplantation were 2.0 ± 1.0 mg/dL (177 ± 88 mmol/L). In conclusion, CRRT provides good metabolic control and allows large ultrafiltration volume in patients supported by an implantable LVAD. We observed a 40% survival rate in patients with combined LVADS and dialytic support, and the survivors all recovered renal function.

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