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1.
J UOEH ; 46(1): 17-21, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38479870

RESUMO

Elevated lactate levels are associated with a poor prognosis in patients with sepsis and shock. Intravenous glycerol administration is often used in Japan to treat patients with acute stroke or brain trauma, but such treatment can cause elevated lactate levels. We experienced a case of transient hyperlactatemia induced by intravenous glycerol administration in a patient with brain trauma. A 74-year-old woman underwent decompressive craniotomy because of loss of consciousness and brain edema. Glycerol was administered after the operation for management of the brain edema. Although the patient's hemodynamics remained stable, her lactate level decreased and increased repeatedly. We recognized that the elevation in her lactate level was associated with the administration of intravenous glycerol. This case suggests that intravenous glycerol administration can induce transient hyperlactatemia.


Assuntos
Edema Encefálico , Lesões Encefálicas Traumáticas , Hiperlactatemia , Humanos , Feminino , Idoso , Hiperlactatemia/induzido quimicamente , Hiperlactatemia/complicações , Glicerol/efeitos adversos , Edema Encefálico/complicações , Lactatos , Estudos Retrospectivos
2.
Pharmacology ; 108(3): 213-223, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36652938

RESUMO

INTRODUCTION: Metformin-treated patients may experience severe hyperlactatemia or lactic acidosis (LA). LA often requires intensive-care-unit (ICU) treatment, and mortality rates are high. Here, we investigate the impact of renal dysfunction and renal replacement therapy (RRT) on the outcomes of critically ill patients with metformin-associated LA (MALA). Furthermore, we assessed associations between mortality and metformin dose, metformin plasma/serum concentrations, lactate level, and arterial pH. Finally, we investigated whether the recommended classification in MALA, metformin-unrelated LA, metformin-induced LA, and LA in metformin therapy appears useful in this regard. METHODS: We performed a retrospective analysis based on a systematic PubMed search for publications on hyperlactatemia/LA in metformin-treated ICU patients from January 1995 to February 2020. Case-level data including demographics and clinical conditions were extracted, and logistic regression analyses were performed. RESULTS: A total of 92 ICU patients were reported. Two of these patients had no comorbidities interfering with lactate metabolism. In the overall group, arterial pH, lactate levels, and metformin plasma/serum concentrations were similar in survivors versus non-survivors. Ingested daily metformin doses and plasma/serum creatinine levels were significantly higher in survivors versus non-survivors (p = 0.007 vs. p = 0.024, respectively). Higher plasma/serum creatinine levels, higher lactate levels, and lower arterial pH were all associated with patients receiving RRT (all p < 0.05). Overall mortality was 22% (20 out of 92 patients) and did not differ between the RRT and non-RRT groups. CONCLUSION: Mortality is high in ICU patients with metformin-associated hyperlactatemia/LA. Unexpectedly, higher ingested metformin dose and plasma/serum creatinine were associated with a better outcome. Survival was similar in patients with or without need for RRT.


Assuntos
Acidose Láctica , Hiperlactatemia , Metformina , Humanos , Hiperlactatemia/induzido quimicamente , Hiperlactatemia/tratamento farmacológico , Acidose Láctica/induzido quimicamente , Acidose Láctica/terapia , Estudos Retrospectivos , Creatinina , Metformina/efeitos adversos , Unidades de Terapia Intensiva , Lactatos/efeitos adversos , Hipoglicemiantes/efeitos adversos
3.
J Cardiothorac Surg ; 17(1): 233, 2022 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-36085208

RESUMO

BACKGROUNDS: Hyperlactatemia is a common metabolic disorder after cardiac surgery with cardiopulmonary bypass. Epinephrine use has been identified as a potential cause of increased lactate levels after cardiac surgery. Stress can lead to an increase in catecholamines, mainly epinephrine, in the body. Exogenous epinephrine causes hyperlactatemia, whereas endogenous epinephrine released by stress may have the same effect. Opioids are the most effective anesthetics to suppress the stress response in the body. The authors sought to provide evidence through a retrospective data analysis that helps investigate the relationship between intraoperative opioid dosage and postoperative lactic acidosis after cardiac surgery. METHODS: The clinical data of 215 patients who underwent valvular heart surgery with cardiopulmonary bypass from July 2016 to July 2019 were analyzed retrospectively. Blood lactate levels were measured at 0.1 h, 2 h, 4 h, and 8 h after surgery. Patients with continuous increases in lactate levels and lactate levels exceeding 5 mmol/L at two or more time points were included in the lactic acidosis group, whereas the other patients were included in the control group. First, univariate correlation analysis was used to identify parameters that were significantly different between the two groups, and then multivariate regression analysis was conducted to elucidate the independent risk factors for lactic acidosis. Fifty-one pairs of patients were screened by propensity score matching analysis (PSM). Then, lactic acid levels at four time points in both groups were analyzed by repeated measures ANOVA. RESULTS: he EF (heart ejection fraction) (OR = 0.94, P = 0.003), aortic occlusion time (OR = 10.17, P < 0.001) and relative infusion rate (OR = 2.23, P = 0.01) of sufentanil was an independent risk factor for lactic acidosis after valvular heart surgery. The patients were further divided into two groups with the mean sufentanil infusion rate as the reference point. The data were filtered with PSM (Propensity Score Matching). Lactic acid values in both groups peaked at 4 h after surgery and then declined. The rate of lactic acid decline was significantly faster in the group with a higher sufentanil dosage than in the lower group. The difference was statistically significant (P < 0.05). There was also a significant difference in lactic acid levels at the four time points (0.1 h, 2 h, 4 h and 8 h after surgery) in both groups (P < 0.001). CONCLUSION: The inadequate intraoperative infusion rate of sufentanil is an independent risk factor for lactic acidosis after heart valve surgery. The possibility of lactic acidosis caused by this factor after cardiac surgery should be considered, which is helpful for postoperative patient management.


Assuntos
Acidose Láctica , Procedimentos Cirúrgicos Cardíacos , Hiperlactatemia , Acidose Láctica/induzido quimicamente , Analgésicos Opioides/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Epinefrina , Valvas Cardíacas/cirurgia , Humanos , Hiperlactatemia/induzido quimicamente , Ácido Láctico , Masculino , Estudos Retrospectivos , Fatores de Risco , Sufentanil/efeitos adversos
4.
Int J Artif Organs ; 45(4): 343-350, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33784842

RESUMO

INTRODUCTION: There were controversial opinions on the use of regional citrate anticoagulation (RCA) versus low molecular weight heparin (LMWH) for continuous renal replacement therapy (CRRT) in hyperlactatemia patients, which was considered as one of the contraindications of citrate. The aim of our present study is to evaluate the efficacy and safety of RCA versus LMWH for CRRT in hyperlactatemia patients. METHODS: Adult patients with hyperlactatemia who underwent RCA or LMWH CRRT in our center between January 2014 and March 2018 were retrospectively recruited. Filter lifespan, ultrafiltration, purification, bleeding, citrate accumulation, filter clot, and the infusion of blood production were evaluated as endpoints. RESULTS: Of the 127 patients included in the original cohort, 81 and 46 accepted RCA and LMWH CRRT, respectively. The filter lifespan was significantly prolonged in the RCA group compared to the LMWH group (44.25 h [2 -83] vs. 24 h [4 -67], p < 0.001). The accumulated filter survival proportions were significantly improved in the RCA group compared to the LMWH group in the original cohort (p < 0.001) as well as the matched group (p < 0.001). The filters clotted more frequently in the LMWH group than in the RCA group in both of the original (52.2% vs 26.8%, p = 0.001) and matched cohort (58.6% vs 19.4%, p = 0.001). The bleeding complication was significantly reduced in the RCA group than in the LMWH group in the matched cohort (28.6% vs 4.5%, p = 0.04). CONCLUSION: In critically ill patients with hyperlactatemia requiring CRRT, RCA is superior to LMWH in terms of filter lifespan and bleeding risk without significantly increased risk of citrate accumulation and citrate related metabolic complications. RCA most likely is a safe and effective anticoagulation method for CRRT in patients with hyperlactatemia.


Assuntos
Terapia de Substituição Renal Contínua , Hiperlactatemia , Adulto , Anticoagulantes/efeitos adversos , Estudos de Casos e Controles , Citratos , Ácido Cítrico , Heparina , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Hiperlactatemia/induzido quimicamente , Terapia de Substituição Renal/métodos , Estudos Retrospectivos
5.
AIDS Res Ther ; 18(1): 56, 2021 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-34481501

RESUMO

BACKGROUND: We report a case of sudden, lethal metabolic acidosis in a 70-year-old man on long-term nucleoside reverse transcriptase inhibitor (NRTI) -based antiretroviral therapy (ART) who had developed atypical necrotizing fasciitis 1 month after kidney transplantation. CASE PRESENTATION: The HIV infection of the patient was treated for the last four months with an integrase strand inhibitor (dolutegravir 50 mg/d) plus a NRTI backbone including lamivudine (150 mg/d) and abacavir (600 mg/d). In this renal transplant patient we hypothesize that the co-existence of sepsis, renal failure and an accumulation of lamivudine led to the development of fatal metabolic acidosis and hyperlactatemia. Although lamivudine is only rarely associated with hyperlactatemia, there is evidence that overdose may be a risk factor for developing it. In our patient the lamivudine concentration two days after stopping and during hemodiafiltration was more than 50 times higher than therapeutic target trough concentrations. Likely reasons for this were renal impairment and concurrent treatment with trimethoprim, known to inhibit the renal elimination of lamivudine. CONCLUSIONS: NRTIs could trigger the development of hyperlactatemia in septic patients. The use of NRTI sparing regimens might be considered in the presence of this critical condition.


Assuntos
Acidose Láctica , Fármacos Anti-HIV , Infecções por HIV , Hiperlactatemia , Transplante de Rim , Lamivudina , Sepse , Acidose Láctica/induzido quimicamente , Idoso , Fármacos Anti-HIV/efeitos adversos , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Hiperlactatemia/induzido quimicamente , Transplante de Rim/efeitos adversos , Lamivudina/efeitos adversos , Masculino , Sepse/tratamento farmacológico
6.
Clin Toxicol (Phila) ; 59(10): 937-941, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33688777

RESUMO

BACKGROUND: Caffeine poisoning may cause life-threatening arrhythmias and hemodynamic failure. We aimed to investigate the toxicokinetics (TK), toxicodynamics (TD) and TK/TD relationships of caffeine in a case of poisoning. CASE REPORT: A 47-year-old male ingested pure anhydrous caffeine powder (70 g) in a suicide attempt. He developed agitation, tachycardia, and two episodes of ventricular fibrillation treated with defibrillation and tracheal intubation. He was successfully managed using intravenous infusions of esmolol and norepinephrine. METHODS: We modelled the time-course of plasma caffeine concentration (TK study using online liquid chromatography-tandem mass spectrometry), the time-course of blood lactate concentration and infusion rates of esmolol and norepinephrine (TD studies) and the TK/TD relationships. RESULTS: Caffeine TK was of first-order peaking at 258 mg/L with an elimination half-life of 46.2 h and clearance of 2.2 L/h. Caffeine-related effects on blood lactate (peak, 10 mmol/L at 1.25 h postingestion) were described by a Bateman-type equation (formation rate, 0.05 mmol/mg.h; elimination rate, 0.9 mmol/mg.h). Esmolol and norepinephrine infusion rates to reverse caffeine-related cardiovascular effects (peaks at 51-h postingestion) fitted well with a sigmoidal Emax model (EC50, 180.0 and 225.9 mg/L, respectively; Hill coefficient, 10.0). CONCLUSION: Massive caffeine ingestion is characterized by prolonged caffeine elimination. TK/TD relationships are helpful to quantify caffeine-related catecholaminergic effects.


Assuntos
Cafeína/envenenamento , Estimulantes do Sistema Nervoso Central/envenenamento , Frequência Cardíaca/efeitos dos fármacos , Tentativa de Suicídio , Taquicardia/induzido quimicamente , Fibrilação Ventricular/induzido quimicamente , Administração Oral , Agonistas alfa-Adrenérgicos/administração & dosagem , Antagonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Cafeína/administração & dosagem , Cafeína/farmacocinética , Cardiotoxicidade , Estimulantes do Sistema Nervoso Central/administração & dosagem , Estimulantes do Sistema Nervoso Central/farmacocinética , Cardioversão Elétrica , Meia-Vida , Humanos , Hiperlactatemia/induzido quimicamente , Infusões Intravenosas , Intubação Intratraqueal , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Norepinefrina/administração & dosagem , Pós , Propanolaminas/administração & dosagem , Taquicardia/diagnóstico , Taquicardia/fisiopatologia , Taquicardia/terapia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia , Fibrilação Ventricular/terapia
7.
Braz J Anesthesiol ; 71(1): 58-64, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33712255

RESUMO

BACKGROUND: Postoperative Hyperlactatemia (PO-HL) is a frequent condition associated with poor prognosis. In recent years, there has been growing evidence that adrenergic stimulation may contribute to increased lactate levels. The use of adrenergic agonists for the control of intraoperative hypotension is frequent, and its impact on the development of PO-HL is unknown. OBJECTIVE: To evaluate whether the use of intraoperative adrenergic agents is associated with the occurrence of PO-HL. METHODS: This was a prospective observational study. The inclusion criteria were undergoing elective open colon surgery, being ≥60 years old and signing informed consent. The exclusion criteria were cognitive impairment, unplanned surgery, and anticipated need for postoperative mechanical ventilation. Baseline and intraoperative variables were collected, and arterial lactate data were collected at baseline and every 6 hours postoperatively for 24 hours. Hyperlactatemia was defined as lactate >2.1 mEq.L-1. RESULTS: We studied 28 patients, 61% of whom developed hyperlactatemia. The variables associated with PO-HL in the univariate analysis were anesthetic time, the total dose of intraoperative ephedrine, and lower intraoperative central venous oxygen saturation (ScvO2). Multivariate analysis confirmed the association between the use of ephedrine (p = 0.004), intraoperative hypotension (p = 0.026), and use of phenylephrine (p = 0.001) with PO-HL. CONCLUSIONS: The use of intraoperative ephedrine, phenylephrine and intraoperative hypotension were independently associated with the development of PO-HL. This finding should lead to new studies in this field, as well as a judicious interpretation of the finding of a postoperative increase in lactate levels.


Assuntos
Hiperlactatemia , Hipotensão , Adrenérgicos , Colo , Efedrina , Humanos , Hiperlactatemia/induzido quimicamente , Hiperlactatemia/epidemiologia , Hipotensão/induzido quimicamente , Hipotensão/epidemiologia , Pessoa de Meia-Idade , Fenilefrina
9.
Mycotoxin Res ; 36(4): 443-452, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32954470

RESUMO

Elevated serum lactate concentration has been used to predict the risk of fatality in various disease states in acutely ill patients or poisoning with different chemicals. However, its utility in predicting disease progression during acute aflatoxicosis has not been investigated. This study was designed to evaluate changes in blood lactate levels following acute exposure to aflatoxin B1 (AFB1) and to determine whether changes in blood lactate levels bear any relationship with biochemical and/or morphological lesions in the stomach, duodenum, and liver. Twenty-one male Wistar rats were randomly divided into three groups (n = 7 rats /group) including Group A (control) receiving vehicle alone and Groups B and C treated with single oral doses of AFB1 at 2.5 and 5 mg/kg, respectively. AFB1 produced significant (p < 0.05) time- and dose-dependent increase in blood lactate concentration as early as 1 h following its administration, with further increases observed at 3 h and 6 h. The hyperlactatemia accompanied tissue oxidative changes including increased H2O2 and MDA, as well as depletion in glutathione, glutathione peroxidase, superoxide dismutase, and total thiols in gastro-duodenal and hepatic tissues. The oxidative changes were reflected in morphological alterations observed at histopathology with more severe lesions observed with the higher dose of AFB1. Serum levels of pro-inflammatory cytokines (TNF-α and IL-1ß) were, however, differently modified by AFB1 administration. Taken together, the results from this study gives indication that hyperlactatemia may find utility in predicting the severity of tissue damage induced by acute AFB1 exposure.


Assuntos
Aflatoxina B1/administração & dosagem , Duodeno/efeitos dos fármacos , Trato Gastrointestinal/efeitos dos fármacos , Hiperlactatemia/induzido quimicamente , Fígado/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Administração Oral , Animais , Citocinas/sangue , Duodeno/patologia , Trato Gastrointestinal/patologia , Hiperlactatemia/patologia , Inflamação/sangue , Lactatos/análise , Lactatos/sangue , Fígado/patologia , Masculino , Oxirredução , Ratos , Ratos Wistar
10.
BMJ Case Rep ; 13(7)2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641306

RESUMO

A 72-year-old Japanese man treated with omeprazole for 11 years was admitted due to loss of consciousness and muscle weakness. Wolff-Parkinson-White syndrome-induced tachycardia was considered as the cause of syncope. His blood examination revealed rhabdomyolysis, hypokalaemia, hypomagnesaemia, hypocalcaemia, hyperlactacidaemia, hyperammonaemia and high-anion-gap metabolic acidosis. Hypomagnesaemia could be caused by magnesium malabsorption due to omeprazole use. Hypocalcaemia might be caused by the inhibitory effect of hypomagnesemia on the parathyroid gland hormone secretion. Hyperammonaemia might be caused by two reasons: (1) renal ammonium production induced by hypokalaemia; (2) inhibition of ammonium secretion by omeprazole. Both hypocalcaemia and hypokalaemia might cause chronic elevation of serum creatinine phosphokinase which ended up with rhabdomyolysis. Correction of serum electrolytes rapidly improved his muscle weakness. Discontinuation of omeprazole no longer caused these abnormalities. A physician should be aware of unexplained signs and symptoms of patients using proton-pump inhibitors to avoid life-threatening electrolyte and physiologic disturbances.


Assuntos
Acidose Tubular Renal/induzido quimicamente , Deficiência de Magnésio/induzido quimicamente , Omeprazol/efeitos adversos , Inibidores da Bomba de Prótons/efeitos adversos , Idoso , Humanos , Hiperamonemia/induzido quimicamente , Hiperlactatemia/induzido quimicamente , Hipocalcemia/induzido quimicamente , Hipopotassemia/induzido quimicamente , Masculino
11.
Medicine (Baltimore) ; 99(15): e19781, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282741

RESUMO

INTRODUCTION: Surgical stress and pain are potential provoking factors for postoperative myasthenic crisis (POMC). We report the occurrence of early POMC and late deep vein thrombosis (DVT) in a man with myasthenia gravis (MG) undergoing thymectomy, addressing possible link between reversal of opioid overdose with naloxone and the triggering of POMC. PATIENT CONCERNS: A 71-year-old man with impaired renal function (ie, estimated glomerular filtration rate [egfr]: 49.1 mL/min/1.73 m) with diagnosis of MG made 2 months ago was scheduled for thymectomy. After uncomplicated surgery, he experienced opioid overdose that was treated with naloxone. Hyperlactatemia then developed with a concomitant episode of hypertension. Three hours after reversal, he suffered from myasthenic crisis presenting with respiratory failure and difficult weaning from mechanical ventilation. DIAGNOSIS: Stress-induced hyperlactatemia and subsequent myasthenic crisis INTERVENTIONS:: Pyridostigmine and immunosuppressive therapy with prednisolone were initiated. Hyperlactatemia subsided on postoperative day (POD) 5. Tracheal extubation was performed successfully on POD 6. OUTCOMES: During the course of hospitalization, his eGFR (ie, 88.9 mL/min/1.73 m) was found to improve postoperatively. After discharge from hospital, he developed DVT in the left femoral and popliteal veins on POD 24 when he was readmitted for immediate treatment with low-molecular-weight heparin. He was discharged without sequelae on POD 31. There was no recurrence of myasthenic crisis or DVT at 3-month follow-up. CONCLUSIONS: Following naloxone administration, hyperlactatemia may be an indicator of pain-related stress response, which is a potential provoking factor for myasthenic crisis. Additionally, patients with MG may have an increased risk of DVT possibly attributable to immune-mediated inflammation. These findings highlight the importance of perioperative avoidance of provoking factors including monitoring of stress-induced elevations in serum lactate concentration, close postoperative surveying for myasthenic crisis, and early recognition of possible thromboembolic complications in this patient population.


Assuntos
Miastenia Gravis/complicações , Timectomia/efeitos adversos , Trombose Venosa/etiologia , Idoso , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Inibidores da Colinesterase/administração & dosagem , Inibidores da Colinesterase/uso terapêutico , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Hiperlactatemia/induzido quimicamente , Hiperlactatemia/diagnóstico , Hiperlactatemia/tratamento farmacológico , Hipertensão/induzido quimicamente , Hipertensão/diagnóstico , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Masculino , Miastenia Gravis/diagnóstico , Miastenia Gravis/cirurgia , Naloxona/efeitos adversos , Antagonistas de Entorpecentes/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/complicações , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Readmissão do Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/patologia , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Brometo de Piridostigmina/administração & dosagem , Brometo de Piridostigmina/uso terapêutico , Respiração Artificial/métodos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Resultado do Tratamento
12.
Br J Cancer ; 122(8): 1141-1145, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32076124

RESUMO

A 47-year-old man with metastatic melanoma presented with refractory hyperlactaemic acidosis following the first dose of the mono-carboxylase transporter 1 inhibitor AZD3965 within a "first time in man" clinical trial. The mechanism of the agent and the temporal relationship suggested that this event was potentially drug related and recruitment was suspended. However, urinary metabolomics showed extensive abnormalities even prior to drug administration, leading to investigations for an underlying metabolic disorder. The lack of clinical symptoms from the elevated lactate and low blood glucose suggested a diagnosis of "hyper-Warburgism", where the high tumour burden was associated with extensive glucose uptake and lactate efflux from malignant cells, and the subsequent impact on blood biochemistry. This was supported by an FDG-PET scan showing extensive glucose uptake in numerous metastases and lack of uptake in the brain. A review of the literature showed 16 case reports of "hyper-Warburgism" in non-haematological malignancies, none of them with melanoma, with most associated with a poor outcome. The patient was treated symptomatically, but died 2 months later. The development of AZD3965 continues with the exclusion of patients with elevated plasma lactate at screening added to the protocol as a safety measure.Trial identification number ClinicalTrials.Gov. NCT01791595.


Assuntos
Acidose Láctica/induzido quimicamente , Hiperlactatemia/induzido quimicamente , Melanoma/tratamento farmacológico , Transportadores de Ácidos Monocarboxílicos/antagonistas & inibidores , Pirimidinonas/efeitos adversos , Simportadores/antagonistas & inibidores , Tiofenos/efeitos adversos , Humanos , Masculino , Melanoma/diagnóstico por imagem , Melanoma/secundário , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons
13.
Ann Emerg Med ; 75(2): 287-298, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31474479

RESUMO

The role of lactic acid and its conjugate base, lactate, has evolved during the past decade in the care of patients in the emergency department (ED). A recent national sepsis quality measure has led to increased use of serum lactate in the ED, but many causes for hyperlactatemia exist outside of sepsis. We provide a review of the biology of lactate production and metabolism, the many causes of hyperlactatemia, and evidence on its use as a marker in prognosis and resuscitation. Additionally, we review the evolving role of lactate in sepsis care. We provide recommendations to aid lactate interpretation in the ED and highlight areas for future research.


Assuntos
Hiperlactatemia/etiologia , Ácido Láctico/sangue , Acidose Láctica/etiologia , Serviço Hospitalar de Emergência , Humanos , Hiperlactatemia/induzido quimicamente , Ácido Láctico/metabolismo , Prognóstico , Sepse/sangue , Sepse/complicações , Deficiência de Tiamina/complicações , Ferimentos e Lesões/complicações
14.
J Diabetes Complications ; 34(1): 107474, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31677983

RESUMO

The FDA has recently endorsed metformin use in patients with T2D and stage 3 CKD (CKD3). However, metformin safety in elderly individuals is unknown. The aim of this study was to identify frequency and risk factors of lactic acid (LA) elevation in ambulatory elderly male US veterans with stable diabetic CKD3 treated with metformin. We studied 92 patients with non-diabetic CKD3 (Group1), diabetic CKD3 not on metformin (Group2) and diabetic CKD3 on metformin (Group 3). Mean LA levels were similar at 1.3 ±â€¯0.3 and 1.3 ±â€¯0.4 mmol/L in Groups 1 and 2, respectively; while, LA was significantly higher in Group 3 (2.1 ±â€¯1.0 mmol/L, P < .001). Only 1 patient in each Groups 1 (4%) and 2 (4%) had hyperlactatemia (LA > 2.0 mmol/L), as compared with 17 (42.5%) patients in Group 3 (P < .05). No differences in age, BMI, eGFR, metformin dosage, and HbA1c were seen in Group 3 patients with and without hyperlactatemia. In the multivariate logistic regression analyses, metformin use was the only factor significantly associated with hyperlactatemia (adjusted OR 25.48, P < .005). In conclusion, metformin therapy is associated with increased risk of hyperlactatemia in elderly men with diabetic CKD3.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Ácido Láctico/sangue , Metformina/uso terapêutico , Insuficiência Renal Crônica/tratamento farmacológico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/complicações , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/patologia , Progressão da Doença , Humanos , Hiperlactatemia/induzido quimicamente , Hiperlactatemia/epidemiologia , Masculino , Metformina/efeitos adversos , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Estados Unidos/epidemiologia , Veteranos/estatística & dados numéricos
15.
Zhonghua Shao Shang Za Zhi ; 35(8): 614-616, 2019 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-31474044

RESUMO

On October 3rd, 2017, one male patient, aged 27 years, was admitted to our hospital 6 hours after hydrothermal scald of torso, buttocks, and limbs. The total area of burn was about 60% total body surface area, and the depth was from deep partial-thickness burn to full-thickness burn. Immediately after admission, the patient was given symptomatic support treatments, such as anti-shock, fluid replacement, and anti-infection, etc. After being treated by debridement and xenogenic (porcine) skin grafting for 2 times, the wounds were healed well. On the 12th day of admission, linezolid was used to prevent infection according to the results of microbial culture and drug sensitivity test, since when the level of his blood lactate continued to increase. After 8 days, linezolid was discontinued and vitamin B1 was given orally for 1 week, and the level of lactic acid gradually decreased to normal in result. This case was used mainly to analyze whether linezolid could directly cause hyperlacticemia and its important mechanism, aiming at reminding clinicians of being alert to the risk of hyperlacticemia when using linezolid. If hyperlacticemia occurs, linezolid should be discontinued immediately and vitamin B1 should be taken orally to correct the high lactic acid value, and the treatment plan should be adjusted if necessary.


Assuntos
Queimaduras/complicações , Hiperlactatemia/induzido quimicamente , Linezolida/efeitos adversos , Adulto , Animais , Queimaduras/cirurgia , Desbridamento , Humanos , Masculino , Transplante de Pele , Suínos
16.
Pharmacotherapy ; 39(9): 946-963, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31361914

RESUMO

Hyperlactatemia and lactic acidosis are two syndromes that are associated with morbidity and mortality. Medication-induced hyperlactatemia and lactic acidosis are diagnoses of exclusion and have the potential to be overlooked. The purposes of this systematic review are to identify published reports of medication-induced lactate level elevations to aid clinicians in diagnosing and comprehending the underlying mechanism of this rare adverse drug effect and to provide management strategies. The PubMed database was searched for case reports, case series, retrospective studies, and prospective studies describing cases of medication-induced lactate level elevation, including lactic acidosis and hyperlactatemia, published between January 1950 and June 2017. A standardized search strategy was used, and the articles identified underwent two rounds of independent evaluation by two reviewers to assess for inclusion. Articles were included if they described at least one patient older than 12 years with hyperlactatemia or lactic acidosis caused by a medication with United States Food and Drug Administration (FDA) approval and if alternative etiologies for an elevated lactate level were ruled out. Metformin and nucleoside/nucleotide reverse transcriptase inhibitors were excluded since the pathophysiology and incidence of lactic acidosis have been well established for these agents. Overall, 1918 articles were identified, and 101 met inclusion criteria. A total of 286 patients experienced medication-induced lactate level elevations, from which 59 unique medications were identified. The most commonly identified agents were epinephrine and albuterol. Medication-induced lactate level elevation was classified as lactic acidosis (64.0%), hyperlactatemia (31.1%), or not specified (4.9%). The doses ingested included FDA-labeled doses (86%), intentional overdoses (10.8%), or prescribed doses exceeding the FDA-labeled dose (3.1%). Medications were continued without a change (40.8%), were permanently discontinued (34.4%), were continued with a dosage reduction (11.6%), or were initially withheld then resumed after lactate level normalized (2.9%); medication management for the remaining 10.0% was not reported. Forty-six patients died (16%). Six deaths were attributed by treating clinicians to be secondary to medication-induced lactic acidosis. Management strategies were heterogeneous, and treatment included supportive care, exogenous bicarbonate therapy, medication specific antidotes, and decontamination strategies. Unexplained lactate level elevations should prompt clinicians to assess for medication-induced lactate level elevations. Pharmacists are members of the health care team that are well positioned to serve as experts in the diagnosis and management of medication-induced lactate level elevations.


Assuntos
Acidose Láctica/induzido quimicamente , Hiperlactatemia/induzido quimicamente , Medicamentos sob Prescrição/efeitos adversos , Relação Dose-Resposta a Droga , Overdose de Drogas/epidemiologia , Humanos , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Estados Unidos
17.
Rev. clín. esp. (Ed. impr.) ; 219(5): 236-242, jun.-jul. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186557

RESUMO

Antecedentes y objetivos: Estudio observacional sobre la diferencia entre el número de casos diagnosticados en situación clínica habitual de acidosis con hiperlactacidemia sospechosa de ser causada por metformina y su incidencia según la ficha técnica. Adicionalmente se exploró la relación con la función renal de la acidosis hiperlactacidémica por metformina. Pacientes: Se identificaron los casos de acidosis entre los años 2013 y 2014 mediante el análisis del CMBD y las peticiones al laboratorio. Se seleccionó a los pacientes que presentaban lactato venoso > 2,7 mmol/L en el momento de ser atendidos y para los que constaba el uso ambulatorio de metformina. La relación causal con la metformina fue evaluada independientemente por varios investigadores. Los casos incidentes se calcularon con base en el número de pacientes a los que se les había dispensado un medicamento que contuviera metformina durante el mismo periodo en el área estudiada. Resultados: Se identificaron 476 casos de acidosis, de los que en 20 se consideró que la metformina era sospechosa de causar el cuadro de acidosis con hiperlactacidemia, lo que supone una incidencia de 6,57/10.000 pacientes. El 85% de los casos presentaban insuficiencia renal aguda. Conclusiones: La incidencia aparente de acidosis con hiperlactacidemia en pacientes tratados con metformina es mayor que la establecida en la ficha técnica (inferior a 1/10.000). El desarrollo de acidosis con hiperlactacidemia por metformina está relacionado con el deterioro agudo de la función renal


Background and objectives: Observational study on the difference between the number of cases of acidosis with hyperlactacidaemia suspected of being caused by metformin diagnosed in standard clinical practice and the incidence of this condition according to the datasheet. The study also explored the relationship between renal function and metformin-associated hyperlactacidaemia acidosis. Patients: We identified cases of acidosis between 2013 and 2014 by analysing the minimum basic data set and laboratory requests. We selected patients who presented venous lactate levels >2.7 mmol/L at the time they were treated and for whom the use of outpatient metformin was confirmed. The causal relationship with metformin was independently evaluated by several researchers. The incident cases were calculated based on the number of patients who had been dispensed a drug containing metformin during the same period in the study area. Results: We identified 476 cases of acidosis. Metformin was suspected of causing the condition of acidosis with hyperlactacidaemia in 20 of these cases, which represents an incidence rate of 6.57/10,000 patients. Eighty-five percent of the cases presented acute renal failure. Conclusions: The apparent incidence of acidosis with hyperlactacidaemia in patients treated with metformin is greater than that established in the datasheet (<1/10,000). The onset of metformin-associated hyperlactacidaemia acidosis is related to acute renal impairment


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Hiperlactatemia/induzido quimicamente , Metformina/efeitos adversos , Injúria Renal Aguda/epidemiologia , Acidose Láctica/induzido quimicamente , Testes de Função Renal/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Acidose Láctica/epidemiologia , Insuficiência Renal Crônica/epidemiologia
19.
Rev Med Interne ; 40(6): 400-403, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-30541659

RESUMO

BACKGROUND: Repeated use of inhaled ß2 agonists is common in asthma or COPD exacerbations. It can lead to hyperlactatemia. CASE REPORTS: We report two asthmatic patients who presented in the emergency department for an asthma exacerbation. The first patient developed hyperlactatemia at 3.9 mmol/L and the second patient developed hyperlactatemia at 5.6 mmol/L after terbutaline treatment. Both patients had a favorable outcome after adjusting the aerosol dose to clinical parameters. DISCUSSION: Lactic acidosis induced by the use of inhaled ß2 agonists is not synonymous of clinical deterioration. However, this side effect may be complicated by a tachypnea compensating for metabolic acidosis and should be known to avoid unnecessary therapeutic escalation.


Assuntos
Agonistas de Receptores Adrenérgicos beta 2/efeitos adversos , Hiperlactatemia/induzido quimicamente , Terbutalina/efeitos adversos , Administração por Inalação , Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Idoso , Asma/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Terbutalina/administração & dosagem
20.
J Intensive Care Med ; 34(11-12): 863-876, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30126348

RESUMO

In the 1920s, guanidine, the active component of Galega officinalis, was shown to lower glucose levels and used to synthesize several antidiabetic compounds. Metformin (1,1 dimethylbiguanide) is the most well-known and currently the only marketed biguanide in the United States, United Kingdom, Canada, and Australia for the treatment of non-insulin-dependent diabetes mellitus. Although phenformin was removed from the US market in the 1970s, it is still available around the world and can be found in unregulated herbal supplements. Adverse events associated with therapeutic use of biguanides include gastrointestinal upset, vitamin B12 deficiency, and hemolytic anemia. Although the incidence is low, metformin toxicity can lead to hyperlactatemia and metabolic acidosis. Since metformin is predominantly eliminated from the body by the kidneys, toxicity can occur when metformin accumulates due to poor clearance from renal insufficiency or in the overdose setting. The dominant source of metabolic acidosis associated with hyperlactatemia in metformin toxicity is the rapid cytosolic adenosine triphosphate (ATP) turnover when complex I is inhibited and oxidative phosphorylation cannot adequately recycle the vast quantity of H+ from ATP hydrolysis. Although metabolic acidosis and hyperlactatemia are markers of metformin toxicity, the degree of hyperlactatemia and severity of acidemia have not been shown to be of prognostic value. Regardless of the etiology of toxicity, treatment should include supportive care and consideration for adjunct therapies such as gastrointestinal decontamination, glucose and insulin, alkalinization, extracorporeal techniques to reduce metformin body burden, and metabolic rescue.


Assuntos
Biguanidas/efeitos adversos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Insuficiência Renal/induzido quimicamente , Acidose/induzido quimicamente , Humanos , Hiperlactatemia/induzido quimicamente , Rim/efeitos dos fármacos
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