RESUMEN
An atypical case of Crimean-Congo haemorrhagic fever is presented. The diagnosis of the case in the presence of several comorbidities was complicated and illustrates the importance of maintaining a high index of suspicion for viral haemorrhagic fever in cases presenting with multisystem disease and an epidemiological history that could present opportunities for exposure to a haemorrhagic fever virus.
Asunto(s)
Fiebre Hemorrágica de Crimea/diagnóstico , Acidosis/diagnóstico , Comorbilidad , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Cetoacidosis Diabética/diagnóstico , Diagnóstico Diferencial , Sobredosis de Droga/diagnóstico , Cefalea/etiología , Fiebre Hemorrágica de Crimea/complicaciones , Fiebre Hemorrágica de Crimea/epidemiología , Humanos , Hipertensión/epidemiología , Hipoglucemiantes/envenenamiento , Masculino , Metformina/envenenamiento , Persona de Mediana Edad , Mialgia/etiología , Obesidad/epidemiología , Hiperplasia Prostática/epidemiología , Trombocitopenia/etiologíaRESUMEN
The medical practitioner is in general well aware of the indications for hemodialysis in severe, acute or chronic renal insufficiency. Apart from the traditional indications for renal replacement therapy, there are some cases such as metfomin and ethylene glycol poisoning, lithium intoxication severe hypercalcemia and tumor lysis syndrome, in which intermittent hemodialysis is the most effective treatment, or sometimes the only effective one. Although these situations remain infrequent, it is crucial to recognize them as quickly as possible.
Asunto(s)
Intoxicación/terapia , Diálisis Renal/métodos , Glicol de Etileno/envenenamiento , Humanos , Compuestos de Litio/envenenamiento , Metformina/envenenamiento , Índice de Severidad de la EnfermedadRESUMEN
INTRODUCTION: Metformin-associated lactic acidosis (MALA) is well described in patients taking therapeutic metformin who develop renal failure or other serious comorbid conditions. Metformin-associated lactic acidosis from acute overdose has also been described in case series but is debated by some clinicians, arguing that metformin overdose does not cause lactic acidosis. Our aim was to perform a multicenter poison control database review to determine if MALA can occur in mono-overdose patients with no comorbid conditions. METHODS: This was a retrospective chart review of the Illinois and Washington Poison Centers between the 2001-2006 and 1999-2006 periods, respectively. Metformin overdoses that were referred to health care facilities were categorized into mono-overdose with or with out MALA and polypharmacy overdose with or without MALA. RESULTS: The overall prevalence of MALA was 14 (3.5%) of 398 cases referred to a health care facility. Metformin-associated lactic acidosis occurred in 9.1% of mono-overdose and in 0.7% of polypharmacy overdose patients referred to health care facilities and was 16% for intentional mono-overdoses. There was one death of 132 mono-overdoses referred to health care facilities. CONCLUSIONS: Apparent metformin mono-overdose is associated with MALA. Dosages that place patients at risk for MALA will require additional study.