scholarly journals Extreme Hyperkalaemia Caused by Concomitant use of a Nsaid and an Ace Inhibitor in an Elderly Patient

2010 ◽  
Vol 61 (2) ◽  
pp. 241-245 ◽  
Author(s):  
Dinko Rogulj ◽  
Marko Hauptfeld ◽  
Mojca Iskra ◽  
Vanda Zorko ◽  
Milena Strašek
Keyword(s):  
Elderly Patient ◽  
Renal Insufficiency ◽  
Laboratory Tests ◽  
Ace Inhibitor ◽  
Elevated Serum ◽  
Laboratory Findings ◽  
Electrolyte Disorder ◽  
Severe Renal Insufficiency ◽  
Life Threatening

Extreme Hyperkalaemia Caused by Concomitant use of a Nsaid and an Ace Inhibitor in an Elderly PatientExtreme hyperkalaemia is a life-threatening electrolyte disorder. It is relatively common in patients with severe renal insufficiency. This report describes a case of extreme hyperkalaemia caused by drugs in an 82-year-old female patient without severe renal insufficiency, who was successfully treated without haemodialysis. The patient had been treated for arterial hypertension and type 2 diabetes mellitus for 30 years. Over the last years she had been receiving enalapril and metformin. Three weeks before the admission to the hospital, she was receiving a non-steroidal anti-inflammatory drug (NSAID) because of the back pain. She was admitted to hospital due to a collapse and weakness in the limbs. Laboratory tests showed extreme hyperkalaemia, high blood sugar, metabolic acidosis, elevated serum creatinine and blood urea nitrogen (BUN), and a slightly elevated serum sodium. On ECG, we noticed typical signs of hyperkalaemia.The patient was treated with a slow intravenous bolus of calcium gluconate and intravenous infusion of sodium chloride with insulin, glucose with insulin and sodium bicarbonte. After the treatment, all laboratory findings normalised together and the patient felt better. This case shows that physicians should be very careful when prescribing NSAIDs to elderly patients treated with drugs that affect renal function.

scholarly journals Hypoglycemia during the Concomitant Use of Repaglinide and Clopidogrel in an Elderly Patient with Type 2 Diabetes and Severe Renal Insufficiency

2021 ◽  
Vol 60 (6) ◽  
pp. 905-910 ◽  
Author(s):  
Kana Takayama ◽  
Kohei Fujii ◽  
Hiroki Yamaguchi ◽  
Yumika Miyoshi ◽  
Yuhei Uehara ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Elderly Patient ◽  
Renal Insufficiency ◽  
Severe Renal Insufficiency

scholarly journals Renal insufficiency and linagliptin therapy: a case report

ABOUTOPEN ◽  
2018 ◽  
Vol 4 (1) ◽  
pp. 140-142
Author(s):  
Anna Corsi ◽  
Roberto Trevisan
Keyword(s):  
Type 2 Diabetes ◽  
Renal Insufficiency ◽  
Severe Renal Impairment ◽  
Minimal Risk ◽  
Oral Drugs ◽  
Severe Renal Failure ◽  
Good Glycemic Control ◽  
Severe Renal Insufficiency ◽  
Increased Risk

The presence of severe renal insufficiency in type 2 diabetes patients often challenges the diabetologist to prescribe a drug therapy, leading to a satisfactory glycemic balance with the minimal risk of hypoglycaemia. Diabetics with renal dysfunction present an increased risk of hypoglycemic episodes, and oral drugs are often ìcontraindications in these patients , especially if they are eliminated by the kidney. This last class of drugs requires a reduction in dosages to avoid the risk of prolonged hypoglycaemic episodes. In particular, in patients with severe renal insufficiency, metformin must be suspended in order to avoid the risk of lactic acidosis. Here we report the case of a young woman with type 2 diabetes, who quickly developed severe renal failure, unfortunately without remission. This case emphasizes the efficacy and safety of insulin-associated linagliptin for good glycemic control in patients with severe renal impairment, with marked reduction in hypoglycaemic episodes (Diabetology).

scholarly journals Advantage of Insulin Glulisine Over Regular Insulin in Patients With Type 2 Diabetes and Severe Renal Insufficiency

2015 ◽  
Vol 25 (2) ◽  
pp. 129-134 ◽  
Author(s):  
Hiromi Urata ◽  
Katsuhito Mori ◽  
Masanori Emoto ◽  
Yuko Yamazaki ◽  
Koka Motoyama ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Renal Insufficiency ◽  
Regular Insulin ◽  
Severe Renal Insufficiency ◽  
Insulin Glulisine

scholarly journals Hyperglycaemic hyperosmolar state in an obese prepubertal girl with type 2 diabetes: case report and critical approach to diagnosis and therapy

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Angelika Mohn ◽  
Nella Polidori ◽  
Valeria Castorani ◽  
Laura Comegna ◽  
Cosimo Giannini ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Elevated Serum ◽  
Serum Glucose ◽  
Critical Approach ◽  
Obese Adults ◽  
Case Presentation ◽  
Threatening Condition ◽  
Life Threatening

Abstract Introduction Isolated Hyperosmolar Hyperglycaemic Syndrome (HHS) is a life-threatening condition characterized by elevated serum glucose concentrations and hyperosmolality without significant ketosis. It is often described in obese adults with unknown Type 2 Diabetes (T2D), rarely in youth. In childhood the most common cause of metabolic glucose related derangement is Diabetic Ketoacidosis (DKA) in Type 1 Diabetes (T1D). Interestingly, both components can be combined with each other, thus the prevalent condition needs to be recognised implying a different therapeutic approach. Case presentation In this case, we report a prepubertal Caucasian obese girl admitted for two episodes of combined HHS/DKA in order to elucidate her clinical course taking into account the current pediatric recommendations based on adult guidelines for HHS. Conclusions The treatment of HHS and even more of HHS/DKA in youth is still controversial as no specific guidelines for children are available especially during the prepubertal age. The description of our case might be helpful and offer relevant points for future consensus.

Metformin-associated lactic acidosis

2021 ◽  
Vol 14 (7) ◽  
pp. e239154
Author(s):  
Emma Jane Fadden ◽  
Christian Longley ◽  
Tushar Mahambrey
Keyword(s):  
Lactic Acidosis ◽  
Ace Inhibitor ◽  
Diabetes Management ◽  
Kidney Injury ◽  
Acid Base ◽  
Rapid Improvement ◽  
Cardiovascular Instability ◽  
Life Threatening ◽  
Education And Awareness

A 58-year-old female with known type 2 diabetes mellitus continued to take her usual medications, including metformin, an ACE inhibitor and a non-steroidal anti-inflammatory drug, while suffering from diarrhoea and vomiting. On presentation to the emergency department, she was found to have a profound lactic acidosis, cardiovascular instability and acute kidney injury. Despite a pH of 6.6, lactate of 14 mmol/L and a brief asystolic cardiac arrest, supportive treatment and the use of renal replacement therapy resulted in rapid improvement in her acid–base abnormalities and haemodynamic parameters. Metformin-associated lactic acidosis is a rare but life-threatening complication of diabetes management. Patient education and awareness amongst clinicians are paramount in the prevention and treatment of this condition.

scholarly journals Laboratory findings in coronavirus disease 2019 (COVID-19) patients: a comprehensive systematic review and meta-analysis

2020 ◽  
Author(s):  
Mohammad Karimian ◽  
Amirreza Jamshidbeigi ◽  
Gholamreza Badfar ◽  
Milad Azami
Keyword(s):  
Interleukin 6 ◽  
Laboratory Tests ◽  
Serum Amyloid A ◽  
Meta Analysis ◽  
Elevated Serum ◽  
Serum Amyloid ◽  
Cochrane Library ◽  
Laboratory Findings ◽  
Amyloid A ◽  
D Dimer

AbstractBackgroundIn early December 2019, the first patient with COVID-19 pneumonia was found in Wuhan, Hubei Province, China. Recent studies have suggested the role of primary laboratory tests in addition to clinical symptoms for suspected patients, which play a significant role in the diagnosis of COVID-19. Therefore, the present study was conducted to evaluate laboratory findings in COVID-19 patients.Data SourcesPubMed/Medline, Scopus, EMBASE, Web of Science (ISI), Cochrane Library, Ovid, Science Direct, CINAHL and EBSCO.Study SelectionCross-sectional of adverse outcomes stratified by the status of ICLs were selected.Data ExtractionThe prevalence of available variables for laboratory tests were extracted.ResultsFinally, 52 studies involving 5490 patients with COVID-19 entered the meta-analysis process. The prevalence of leukopenia, lymphopenia, elevated c-reactive protein (CRP), elevated erythrocyte sedimentation rate (ESR), elevated serum amyloid A, elevated ferritin was estimated to be 20.9% (95%CI: 17.9-24.3), 51.6% (95%CI: 44.0-59.1), 63.6% (95%CI: 57.0-69.8), 62.5% (95%CI: 50.1-73.5), 63.6% (95%CI: 57.0-69.8), 62.5% (95%CI: 50.1-73.5), 74.7% (95%CI: 50.0-89.7), and 72.6% (95%CI: 58.1-83.5), respectively. The prevalence of elevated interleukin-6 was 59.9% (95%CI: 48.2-70.5), CD3 was 68.3% (95%CI: 50.1-82.2), reduced CD4 was 62.0% (95%CI: 51.1-71.6), reduced CD8 was 42.7% (95%CI: 32.2-53.9). The prevalence of elevated troponin-I was 20.6% (95%CI: 9.0-40.5), elevated creatine kinase-MB (CKMB) was 14.7% (95%CI: 7.1-28.0), elevated brain natriuretic peptide (BNP) was 48.9% (95%CI: 30.4-67.7), elevated blood urea nitrogen was 13.1% (95%CI: 6.6-24.4),, elevated creatinine was 7.2% (95%CI: 4.4-11.8), elevated lactate dehydrogenase (LDH) was 53.1% (95%CI: 43.6-62.4), hyperglycemia was 41.1% (95% CI: 28.2-55.5), elevated total bilirubin was 48.9% (95%CI: 30.4-67.7), reduced albumin was 54.7% (95%CI: 38.1-70.2), reduced pre-albumin was 49.0% (95%CI: 26.6-71.8), and reduced PT was 53.1% (95% CI: 43.6-62.4), and D-dimer was 44.9% (95%CI: 31.0-59.6).ConclusionThis study provides a comprehensive description of laboratory characteristics in patients with COVID-19. The results show that lymphopenia, elevated CRP, elevated ESR, elevated ferritin, elevated serum amyloid A, elevated BNP, reduced albumin, reduced pre-albumin, reduced CD3, reduced CD4, reduced CD8, elevated D-dimer, reduced PT, elevated interleukin-2, elevated interleukin-6, elevated LDH and hyperglycemia are the common findings at the time of admission.

Proposal for the administration of metformin in patients with chronic kidney disease

2012 ◽  
Vol 153 (39) ◽  
pp. 1527-1535 ◽  
Author(s):  
Zoltán Balogh ◽  
János Mátyus
Keyword(s):  
Lactic Acidosis ◽  
Chronic Renal Disease ◽  
Antidiabetic Agent ◽  
First Line ◽  
Oral Antidiabetic Agent ◽  
Oral Antidiabetic ◽  
Cardiovascular Morbidity And Mortality ◽  
Glomerular Filtrate ◽  
Life Threatening

Metformin is the first-line, widely used oral antidiabetic agent for the management of type 2 diabetes. There is increasing evidence that metformin use results in a reduction in cardiovascular morbidity and mortality, and might have anticancer activity. An extremely rare, but potentially life-threatening adverse effect of metformin is lactic acidosis, therefore, its use is traditionally contraindicated if the glomerular filtrate rate is below 60 mL/min. However, lactic acidosis is always associated with acute events, such as hypovolemia, acute cardiorespiratory illness, severe sepsis and acute renal or hepatic failure. Furthermore, administration of insulins and conventional antihyperglycemic agents increases the risk of severe hypoglycemic events when renal function is reduced. Therefore, the magnitude of the benefit of metformin use would outweigh potential risk of lactic acidosis in moderate chronic renal disease. After reviewing the literature, the authors give a proposal for the administration of metformin, according to the calculated glomerular filtrate rate. Orv.Hetil., 2012, 153, 1527–1535.

Acute Increase in Creatinine after Starting ACE Inhibitor and Vascular Events and Premature Death in Patients with Type 2 Diabetes—The ADVANCE Trial

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1483-P
Author(s):  
TOSHIAKI OHKUMA ◽  
MIN JUN ◽  
MARK WOODWARD ◽  
JOHN CHALMERS ◽  
VLADO PERKOVIC ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Ace Inhibitor ◽  
Premature Death ◽  
Vascular Events ◽  
Acute Increase
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