[Acute respiratory failure in neuromuscular disease]. / Insuffisance respiratoire aiguë et maladies neuromusculaires.

Neuromuscular diseases can affect all respiratory muscles, leading to acute respiratory failure, which is the most common cause of morbidity and mortality in those patients. Two situations must be distinguished. 1) Acute respiratory failure as part of a neuromuscular disorder of acute onset and possibly reversible (Guillain-Barre syndrome, myasthenic crisis...). 2) Acute respiratory failure occurring in a patient with an already advanced neuromuscular disease (amyotrophic lateral sclerosis, Duchenne muscular dystrophy...). This article describes the neuromuscular acute respiratory failure in these different aspects, discusses its initial management in the emergency department and identifies the parameters that have to be monitored.

[Toxicity of metformin, pro- or con- a future restriction to its contraindications?]. / Toxicité de la metformine: pour ou contre une restriction de ses contre-indications?

Type 2 diabetes, a world-wide epidemic, is a major concern of health systems around the world. The recommandation of its early management with metformin by the majority of guidelines has made metformin the object of multiple studies to demonstrate its benefits, but more importantly its side effects among whom the most serious is lactic acidosis. The latter is rare, but responsible for high mortality rates and is strongly associated with acute and chronic conditions for which diabetics are prone. These conditions reduce tissue perfusion and activate anaerobic metabolism producing lactate. Despite the beneficial effects of metformin and the debate about its causal role, we should remain vigilant about this serious complication by respecting its usage's contraindications, for the time being unchanged.