scholarly journals Profound Metabolic Acidosis due to Metformin Intoxication Requiring Dialysis

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Klodia Hermez ◽  
Carla Dudash-Mion
Keyword(s):  
Renal Function ◽  
Lactic Acid ◽  
Metabolic Acidosis ◽  
Mortality Rates ◽  
Clinical Suspicion ◽  
Intermittent Hemodialysis ◽  
Unique Case ◽  
Threatening Condition ◽  
Bicarbonate Therapy ◽  
Life Threatening

Metformin-associated lactic acidosis (MALA) is a rare but life-threatening condition with often high mortality rates. Despite this, metformin continues to be one of the most commonly prescribed antihyperglycemic agents in the market. We present a unique case of a 61-year-old female with severe acidosis of pH = 6.72 and lactic acid of 26 mmol/L who presented obtunded after ingestion of an unknown amount of metformin. She was subsequently intubated, became hypotensive, and was initiated on vasopressors. She was swiftly started on a combination of intermittent hemodialysis (IHD) and bicarbonate therapy 7 hours after admission followed by continuous renal replacement therapy (CRRT) as she became more hemodynamically unstable. The patient’s renal function improved, and she was discharged 7 days after admission with favorable sequelae. Dialysis is often reported in cases of severe MALA; however, it remains unclear how quickly dialysis should be initiated. This case aims to explore the benefits of quick initiation of extracorporeal measures in the forms of IHD and CRRT with concurrent bicarbonate supplementation. Furthermore, this case demonstrates the importance of clinical suspicion in metabolic acidosis in a patient on metformin therapy.

scholarly journals DRESS Syndrome due to Nevirapine Treated with Methylprednisolone

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Henrique Pott Junior ◽  
Gisele Cristina Gosuen ◽  
Ana Cristina Gales
Keyword(s):  
Clinical Presentation ◽  
Mortality Rates ◽  
Multiple Organ ◽  
Clinical Suspicion ◽  
Significant Morbidity ◽  
Dress Syndrome ◽  
Infected Female ◽  
Threatening Condition ◽  
Life Threatening ◽  
Systemic Symptoms

Nevirapine-induced DRESS syndrome is uncommon but a potentially life-threatening condition, with significant morbidity and mortality rates due to multiple-organ involvement. The authors report a case of a 47-year-old HIV-infected female patient who presented with fever, right hypochondrium pain, jaundice, and skin rash. The Nevirapine-induced DRESS syndrome was suspected based on clinical presentation and RegiSCAR scoring system. This case highlights the need for a high index of clinical suspicion among HIV-infected patients with severe skin eruption and systemic symptoms.

scholarly journals Basilar Artery Occlusion. Clinical Evaluation and Contemporary Methods of Treatment

2021 ◽  
Vol 4 (01) ◽  
pp. 01-08
Author(s):  
Damyan Boychev
Keyword(s):  
Basilar Artery ◽  
Neurological Diseases ◽  
Intravenous Thrombolysis ◽  
Mortality Rates ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Threatening Condition ◽  
Life Threatening ◽  
Methods Of Treatment ◽  
Headache And Neck Pain

Acute occlusion of the basilar artery and its branches is a frequent cause of posterior circulation strokes. Although it accounts for only 1 to 3 % of ischemic strokes, it is a potentially life-threatening condition associated with high mortality rates. Exact clinical diagnosis is still challenging because symptoms such as vertigo, dizziness followed by headache, and neck pain are nonspecific and usually attributed to many other neurological diseases. The onset of symptoms can be abrupt or gradual and progressive. Establishing the time of symptoms onset and making a timely diagnosis is highly important. In case the diagnosis is made promptly, ideally with the help of an advanced neuroimaging, intravenous thrombolysis, or catheter-based endovascular treatment can be performed immediately to improve prognosis and reduce mortality.

A rare case of rhabdomyolysis and acute renal failure following spinal surgery

2008 ◽  
Vol 9 (4) ◽  
pp. 387-389 ◽  
Author(s):  
Michael Papadakis ◽  
George Sapkas ◽  
Apostolos Tzoutzopoulos
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Spinal Surgery ◽  
Rare Case ◽  
Neurogenic Claudication ◽  
Intermittent Hemodialysis ◽  
Lumbar Surgery ◽  
Adequate Treatment ◽  
Threatening Condition ◽  
Life Threatening

Spinal surgery–associated rhabdomyolysis, although rare, is a life-threatening condition. Presented here is the case of a middle-aged, overweight man who underwent posterior lumbar surgery because of pain and neurogenic claudication. His postoperative course was complicated by the occurrence of rhabdomyolysis. Despite adequate treatment, acute renal failure developed as a sequela. His condition was grave enough to require the administration of intermittent hemodialysis. After a prolonged hospitalization and 5 sessions of hemodialysis, the patient achieved a full recovery. In view of the fact that rhabdomyolysis-induced acute renal failure is associated with a mortality rate of 20–50%, the outcome was favorable.

scholarly journals Nonuremic calciphylaxis in a post renal transplant patient

2019 ◽  
Vol 8 (2) ◽  
pp. 20-20 ◽  
Author(s):  
Maria Srour ◽  
Bahar Bastani
Keyword(s):  
Renal Function ◽  
Sodium Thiosulfate ◽  
Type Ii Diabetes Mellitus ◽  
African American Female ◽  
Poor Renal Function ◽  
Threatening Condition ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage ◽  
Living Related

Background: Calciphylaxis is a potentially fatal condition previously observed in patients with poor renal function. We present a case of atypical presentation in a patient with good renal function after transplantation. Case Presentation: A-68-year old African American female with history of end-stage renal disease (ESRD) secondary to type II diabetes mellitus on hemodialysis for ten years, status post living related donor kidney transplant from her son three years prior to this presentation, parathyroidectomy, and atrial fibrillation on warfarin presented to our institution with progressively worsening, severely tender bilateral thigh lesions that were diagnosed as calciphylaxis. She was treated with sodium thiosulfate infusions for six months and continues to do well. Conclusions: Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), has traditionally been associated with ESRD patients on maintenance dialysis, however several nonuremic cases of CUA have been reported in recent years. Multiple pathophysiologic mechanisms for CUA development have been proposed expanding the scope of known risk factors and possible triggers. CUA can be a life-threatening condition that is important for clinicians to recognize and treat as soon as possible.

scholarly journals Severe Metformin Poisoning Successfully Treated with Simultaneous Venovenous Hemofiltration and Prolonged Intermittent Hemodialysis

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Dovile Leonaviciute ◽  
Bo Madsen ◽  
Anne Schmedes ◽  
Niels H. Buus ◽  
Bodil S. Rasmussen
Keyword(s):  
Mortality Rate ◽  
Lactic Acidosis ◽  
Intermittent Hemodialysis ◽  
Continuous Venovenous Hemofiltration ◽  
Cardiovascular Collapse ◽  
Circulatory Collapse ◽  
Patient Case ◽  
Threatening Condition ◽  
Life Threatening ◽  
Lactate Acidosis

Metformin poisoning is a life-threatening condition with a high mortality rate. We present a patient case of metformin poisoning following intake of 80 g metformin resulting in severe lactate acidosis with a nadir pH of 6.73 and circulatory collapse, successfully treated with addition of prolonged intermittent hemodialysis (HD) to continuous venovenous hemofiltration (CVVH). The patient’s pH became normal 48 hours after metformin ingestion during simultaneous CVVH and addition of 22 hours of intermittent HD in the ICU. The highest metformin level was found to be 991 μmol/L (therapeutic range 3.9–23.2 μmol/L). We conclude that in cases of severe metformin poisoning with circulatory shock and extreme lactic acidosis, the usual CVVH modality might not efficiently clear metformin. Therefore, additional prolonged HD should be considered even in the state of cardiovascular collapse with vasopressor requirement.

Evaluation and Anesthetic Management for Patients With Cardiac Trauma

2019 ◽  
pp. 348-359
Author(s):  
Daniel Smith ◽  
Eric Ness ◽  
Amanda M. Kleiman
Keyword(s):  
Anesthetic Management ◽  
Clinical Suspicion ◽  
Operating Conditions ◽  
Mechanical Support ◽  
Cardiovascular Collapse ◽  
Cardiac Trauma ◽  
Complex Patients ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Level

Cardiac trauma, either blunt or penetrating, is a life-threatening condition often requiring immediate intervention. Cardiac trauma causes varied hemodynamic effects, from stable arrhythmia to cardiovascular collapse. The diagnosis of cardiac trauma relies on a high level of clinical suspicion paired with imaging, including transthoracic echocardiography. Anesthetic management for cardiac trauma focuses primarily on maintenance of preload and cardiac function while optimizing operating conditions for surgical repair. Depending on the injuries involved, support that includes inotropes, vasopressors, and potentially mechanical support may be required. This chapter discusses the pathophysiology and presentation of cardiac trauma and explores the intricate anesthetic management of these complex patients.

scholarly journals Spontaneous Splenic Rupture Complicating Severe P. falciparum Infection: A Case Report and Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Eltaib Saad ◽  
Elamin Elsamani ◽  
Walid Abdelrahman
Keyword(s):  
Clinical Presentation ◽  
Splenic Rupture ◽  
Clinical Suspicion ◽  
Successful Outcome ◽  
Spontaneous Splenic Rupture ◽  
Malarial Infection ◽  
Threatening Condition ◽  
Life Threatening ◽  
Missed Diagnosis ◽  
Rupture Of The Spleen

Spontaneous rupture of the spleen in malarial infection or malarial splenic rupture (MSR) is a rare but life-threatening condition complicating severe malarial infection in tropics and subtropics, and hence it deserves special attention. A high index of clinical suspicion is warranted for the early diagnosis as delayed or missed diagnosis can be potentially fatal. We report on a 32-year-old male who was diagnosed with severe Plasmodium falciparum infection and presented with an acute abdomen due to spontaneous splenic rupture. He was managed conservatively and had a successful outcome. The epidemiology, pathophysiology, clinical presentation, and management of MSR were briefly discussed in this report.

scholarly journals A Young Diabetic Lady with Emphysematous Pyelonephritis

1970 ◽  
Vol 13 (1) ◽  
pp. 72-74
Author(s):  
Ahmad Mursel Anam ◽  
Farzana Shumy ◽  
Mohammad Mufizul Islam Polash ◽  
Raihan Rabbani ◽  
Abed Hussain Khan ◽  
...  
Keyword(s):  
Septic Shock ◽  
Paralytic Ileus ◽  
Clinical Suspicion ◽  
Abdominal Radiograph ◽  
Emphysematous Pyelonephritis ◽  
Plain Abdominal Radiograph ◽  
Threatening Condition ◽  
Life Threatening ◽  
Fluid Levels ◽  
High Degree

A rare and potentially life-threatening condition is reported. A young diabetic lady presented with septic shock and features of paralytic ileus. A plain abdominal radiograph suggested “megacolon with gas-fluid levels”. But high degree of clinical suspicion persuaded us to perform a CT scan of abdomen, which revealed emphysematous pyelonephritis. This enabled us to start early effective treatment and eventually save the patient. DOI: http://dx.doi.org/10.3329/jom.v13i1.10055 JOM 2012; 13(1): 72-74

The effect of sodium bicarbonate administration on renal function: A systematic review and meta-analysis of clinical trials

2021 ◽  
Author(s):  
Mohammad Tavassoly ◽  
Firouzeh Moeinzadeh ◽  
Elham-Sadat Hejazi ◽  
Cain C. T. Clark ◽  
Mohammad Hossein Rouhani
Keyword(s):  
Systematic Review ◽  
Renal Function ◽  
Metabolic Acidosis ◽  
Serum Creatinine ◽  
Sodium Bicarbonate ◽  
Creatinine Clearance ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Study Heterogeneity ◽  
Bicarbonate Therapy

Abstract Background Metabolic acidosis is a prevalent condition in patients with chronic kidney disease (CKD). Although sodium bicarbonate is extensively used for management of metabolic acidosis, its efficacy has not been summarized in previous review studies. Objective To conduct a systematic review and meta-analysis to estimate the overall effects of sodium bicarbonate on indices of renal function in patients with CKD. Methods A systematic literature search was carried out through the Medline, Web of Science and Scopus databases, up to July 2020. Studies that reported the effects of oral sodium bicarbonate administration on renal function were included. Blood urea nitrogen (BUN), serum creatinine, glomerular filtration rate (GFR), and creatinine clearance were defined as renal function indices. A random-effects model was used to calculate the overall effect and reported as weighted mean difference (WMD). Results Thirteen studies were included in this systematic review and meta-analysis. A beneficial effect of sodium bicarbonate was observed on BUN (WMD: − 8.63 mg/dL; 95% CI: -11.08, -6.19), serum creatinine (WMD: -0.19 mg/dL; 95% CI: -0.36, -0.02), GFR (WMD: 0.75 ml/min/1.73 m2; 95% CI: 0.14, 1.35), and creatinine clearance (WMD: 4.82 mL/min; 95% CI: 2.68, 6.96). There was no between study heterogeneity for all renal function indices. Also, no publication bias was observed in this study. Conclusion This systematic review and meta-analysis showed that sodium bicarbonate supplementation could increase GFR and creatinine clearance and decrease BUN and creatinine. Therefore, sodium bicarbonate therapy may efficacious in ameliorating the progression of CKD.

A Retrospective Study of Factors Influencing Survival Following Surgery for Gastric Dilatation-Volvulus Syndrome in 306 Dogs

2010 ◽  
Vol 46 (2) ◽  
pp. 97-102 ◽  
Author(s):  
George Mackenzie ◽  
Mathew Barnhart ◽  
Shawn Kennedy ◽  
William DeHoff ◽  
Eric Schertel
Keyword(s):  
Mortality Rate ◽  
Cardiac Arrhythmias ◽  
Gastric Resection ◽  
Postoperative Mortality ◽  
Mortality Rates ◽  
Gastric Dilatation ◽  
Factors Influencing ◽  
Threatening Condition ◽  
Life Threatening ◽  
Overall Mortality

Gastric dilatation-volvulus (GDV) is a life-threatening condition in dogs that has been associated with high mortality rates in previous studies. Factors were evaluated in this study for their influence on overall and postoperative mortality in 306 confirmed cases of GDV between 2000 and 2004. The overall mortality rate was 10%, and the postoperative mortality rate was 6.1%. The factor that was associated with a significant increase in overall mortality was the presence of preoperative cardiac arrhythmias. Factors that were associated with a significant increase in postoperative mortality were postoperative cardiac arrhythmias, splenectomy, or splenectomy with partial gastric resection. The factor that was associated with a significant decrease in the overall mortality rate was time from presentation to surgery. This study documents that certain factors continue to affect the overall and postoperative mortality rates associated with GDV, but these mortality rates have decreased compared to previously reported rates.

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