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1.
J Med Case Rep ; 15(1): 17, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33472652

RESUMO

BACKGROUND: Metformin-associated lactic acidosis (MALA) is a widely documented adverse event of metformin. Despite being considered one of the main causes of metabolic acidosis, the association between an anion gap and MALA diagnosis is still uncertain. CASE PRESENTATION: Cases involving six Caucasian patients with suspected MALA who were admitted to the emergency department were analysed. All these patients presented with pH values < 7.35, lactate levels > 2 mmol/L, and estimated glomerular filtration < 30 mL/min. Metformin plasma concentrations were > 2.5 mg/L in all the patients. The highest metformin concentrations were not found in the patients with the highest lactate levels. The anion gap values ranged from 12.3 to 39.3, with only two patients exhibiting values > 14. CONCLUSIONS: In patients with MALA, there is a significant variability in the anion gap values, which is not related to the level of metformin accumulation, and therefore, it is doubtful whether measuring anion gaps is useful as an approach for MALA diagnosis.


Assuntos
Equilíbrio Ácido-Base , Acidose Láctica/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Acidose Láctica/sangue , Acidose Láctica/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Ânions/sangue , Cátions/sangue , Feminino , Humanos , Ácido Láctico/sangue , Masculino , Metformina/sangue , Pessoa de Meia-Idade
3.
Medicine (Baltimore) ; 99(41): e22492, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031284

RESUMO

RATIONALE: Metformin-associated lactic acidosis (MALA) is a rare adverse effect that has significant morbidity and mortality. MALA is a high anion gap (AG), nonosmolar acidosis. Associated osmolar-gap (OG) is rarely reported, so finding an OG may make the diagnosis of MALA challenging. PATIENT CONCERNS: Forty-five years' old type II diabetic patient on metformin presented to emergency with a two-day history of vomiting, watery diarrhea, and mild abdominal discomfort. On examinations, he looked dehydrated. Investigation revealed acute kidney injury (AKI) with a high lactic acid (LA) level of 24 mmol/L, pH of 6.8, AG of 40, and an OG of 20 mOsm/kg DIAGNOSES:: The presence of an OG made the diagnosis challenging; the history was negative for alcohol, osmolar substance, or illicit drug ingestion or use. The toxicology screen was negative. After ruling out plausible causes of AG and OG, MALA was deemed the likely reason for his presentation likely precipitated by dehydration and AKI. INTERVENTIONS: He underwent two sessions of hemodialysis, afterward managed with fluid hydration. OUTCOMES: On day 3, he was in the polyuric phase suggestive of acute tubular necrosis. His serum creatinine improved afterward with improved acidosis; after 8 days, he was discharged in stable condition. LESSONS: MALA is a rare side effect of metformin therapy. Acute kidney injury is a known precipitant of MALA. In our review, we highlight the association of MALA and the presence of an OG. We believe that treating physicians should be aware of this relationship to avoid delaying or overlooking such an important diagnosis.


Assuntos
Acidose Láctica/sangue , Acidose Láctica/induzido quimicamente , Lesão Renal Aguda/complicações , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Concentração Osmolar , Desequilíbrio Ácido-Base , Acidose Láctica/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade
4.
Praxis (Bern 1994) ; 109(12): 979-983, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32933388

RESUMO

Lactic Acidosis and Other Misunderstandings Abstract. Lactic acidosis is a frequently encountered clinical problem in intensive care medicine. Nevertheless, many of the underlying biochemical processes are insufficiently understood, which leads to various misconceptions. Physiologically, lactate is an important, continuously produced carrier of energy and by no means a metabolic 'waste product'. Lactate is the corresponding base to lactic acid and is produced directly from pyruvate. In this reaction H+ is consumed and therefore lactate production itself cannot be directly responsible for the simultaneously arising acidosis. An elevated lactate level allows no conclusions about the underlying pathophysiological process, and, more importantly, it is not an appropriate marker for tissue oxygenation.


Assuntos
Acidose Láctica , Acidose , Acidose Láctica/diagnóstico , Acidose Láctica/terapia , Biomarcadores , Cuidados Críticos , Humanos , Ácido Láctico
5.
Ann Biol Clin (Paris) ; 78(4): 417-424, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32753366

RESUMO

We present the case of a four-year-old girl, who was hospitalized in intensive care unit for a coma resulting from metabolic acidosis with increased anion gap. The patient was treated for short bowel syndrome, following necrotising enterocolitis, which occurred 51 days after birth. In our initial evaluation of the patient's metabolic acidosis, we were unable to identify the cause of the increased anion gap. Urinary organic acids chromatography identified a large peak of lactate (quantified at 15 mmol/mol of creatiniuria), as well as its metabolites. The discrepancy between normal blood lactate concentration assayed by enzymatic assay, and the large amount of lactate found by gas-chromatography/mass spectrometry (GC/MS) in urine highlights the limit of the stereospecificity of enzymatic assays. Indeed, most lactates assay use enzymatic assays that are specific for L-lactate, whereas organic acids chromatography, whose column is mostly achiral, can detect both stereoisomers, D- and L-lactate. Organic acids in urine analysis, in addition to the clinical context, suggested a diagnosis of D-lactic acidosis. Following a review of the physiopathology and treatment of short bowel syndrome, we will discuss the mechanism and diagnosis of the D-lactic acidosis in our patient. This case highlights the need to perform an organic acid profile in urine in the presence of any unexplained increased anion gap to determine its cause.


Assuntos
Equilíbrio Ácido-Base/fisiologia , Acidose Láctica/diagnóstico , Acidose/diagnóstico , Coma/diagnóstico , Síndrome do Intestino Curto/diagnóstico , Acidose/etiologia , Acidose/metabolismo , Acidose Láctica/etiologia , Acidose Láctica/metabolismo , Acidose Láctica/urina , Análise Química do Sangue/métodos , Pré-Escolar , Coma/sangue , Coma/etiologia , Coma/urina , Diagnóstico Diferencial , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Ácido Láctico/sangue , Ácido Láctico/urina , Síndrome do Intestino Curto/complicações , Síndrome do Intestino Curto/metabolismo , Urinálise
6.
Medicine (Baltimore) ; 99(8): e19141, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080090

RESUMO

INTRODUCTION: Stroke-like episodes (SLEs) are typical cerebral manifestations of certain mitochondrial disorders (MIDs). They are characterised by a vasogenic edema in a non-vascular distribution. PATIENTS CONCERNS:: none DIAGNOSIS:: SLEs show up on cerebral MRI as stroke-like lesions (SLLs), characterised by vasogenic edema in a non-vascular distribution. SLLs expand in the acute stage and regress during the chronic stage. They show hyperperfusion in the acute stage and hypoperfusion in the chronic stage. INTERVENTIONS: SLLs respond favorably to antiseizure drugs, to No-precursors, steroids, the ketogenic diet, and antioxidants. OUTCOME: SLLs end up as normal tissue, white matter lesion, grey matter lesion, cyst, laminar cortical necrosis, or the toenail sign. CONCLUSIONS: SLLs are a frequent manifestation of MIDs. They undergo dynamic changes in the acute and chronic stage. They need to be differentiated from ischemic stroke as they are differentially treated.


Assuntos
Encefalopatias Metabólicas Congênitas/tratamento farmacológico , Encefalite/tratamento farmacológico , Síndrome MELAS/diagnóstico por imagem , Síndrome MELAS/genética , Doenças Mitocondriais/complicações , Acidente Vascular Cerebral/tratamento farmacológico , Acidose Láctica/diagnóstico , Anticonvulsivantes/uso terapêutico , Antioxidantes/uso terapêutico , Grupo com Ancestrais do Continente Asiático/etnologia , Encefalopatias Metabólicas Congênitas/complicações , Encefalopatias Metabólicas Congênitas/diagnóstico , Edema Encefálico/diagnóstico por imagem , Criança , DNA Mitocondrial/genética , Diagnóstico Diferencial , Dieta Cetogênica/efeitos adversos , Dieta Cetogênica/métodos , Encefalite/diagnóstico , Humanos , Síndrome MELAS/tratamento farmacológico , Síndrome MELAS/patologia , Imagem por Ressonância Magnética , Masculino , Encefalomiopatias Mitocondriais/diagnóstico , Fosforilação Oxidativa/efeitos dos fármacos , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/patologia
7.
Biochem Med (Zagreb) ; 30(1): 011001, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31839728

RESUMO

Introduction: D-lactic acidosis is an uncommon cause of high anion gap acidosis. Materials and methods: A 35-year old woman was admitted to the emergency room with somnolence, drowsiness, dizziness, incoherent speech and drunk appearance. Her past medical history included a Roux-en-Y bypass. Point-of-care venous blood analysis revealed a high anion gap acidosis. Based on the clinical presentation, routine laboratory results and negative toxicology screening, D-lactate and 5-oxoprolinuria were considered as the most likely causes of the high anion gap acidosis. Urine organic acid analysis revealed increased lactate, but no 5-oxoproline. Plasma D-lactate was < 1.0 mmol/L and could not confirm D-lactic acidosis. What happened: Further investigation revealed that the blood sample for D-lactate was drawn 12 hours after admission, which might explain the false-negative result. Data regarding the half-life of D-lactate are, however, scarce. During a second admission, one month later, D-lactic acidosis could be confirmed with an anion gap of 40.7 mmol/L and a D-lactate of 21.0 mmol/L measured in a sample collected at the time of admission. Main lesson: The time of blood collection is of utmost importance to establish the diagnosis of D-lactic acidosis due to the fast clearance of D-lactate in the human body.


Assuntos
Acidose/diagnóstico , Ácido Láctico/urina , Acidose Láctica/diagnóstico , Adulto , Reações Falso-Positivas , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Ácido Láctico/sangue , Fase Pré-Analítica
8.
BMJ Case Rep ; 12(10)2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666256

RESUMO

A 63-year-old woman with a prior history of chronic lower extremity lymphedema came to the hospital for evaluation of new-onset left leg pain and swelling associated with haemorrhagic blisters and foul-smelling discharge. Relevant history included a recent trip to a Hudson River Valley beach in New York 1 week prior to hospitalisation. Laboratory evaluation revealed significant leukocytosis and lactic acidosis. She was found to have sepsis and bacteremia secondary to Vibrio cholerae (serotype non-O1, non-O139). During a prolonged intensive care unit course requiring intravenous pressor support and broad-spectrum antibiotics, she underwent debridement of her left foot eschar along with skin grafting. Once clinically stable and improved, she was discharged to a subacute rehabilitation centre with close follow-up for wound care. V. cholerae infection is rare and often benign but can be transmitted from contaminated seawater to individuals with underlying chronic illness and cause severe symptoms, including sepsis.


Assuntos
Sepse/microbiologia , Dermatopatias Infecciosas/cirurgia , Vibrioses/diagnóstico , Vibrio cholerae/isolamento & purificação , Acidose Láctica/diagnóstico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Vesícula/diagnóstico , Vesícula/etiologia , Desbridamento/métodos , Diagnóstico Diferencial , Feminino , Pé/microbiologia , Pé/patologia , Hemorragia/etiologia , Humanos , Unidades de Terapia Intensiva , Leucocitose/diagnóstico , Pessoa de Meia-Idade , Sepse/tratamento farmacológico , Dermatopatias Infecciosas/microbiologia , Transplante de Pele/métodos , Resultado do Tratamento , Vasoconstritores/administração & dosagem , Vasoconstritores/uso terapêutico , Vibrioses/epidemiologia
9.
Clin Lab ; 65(10)2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31625353

RESUMO

BACKGROUND: Lung involvement is rare in peripheral T cell lymphoma, and there is a lack of sufficient clinical study. The authors describe a rare case of lung involvement in a 40-year-old male patient with peripheral T cell lymphoma. METHODS: Hematological investigation, bone marrow aspirate, and lung biopsy were performed. RESULTS: The patient received 4 courses of CHOP regimen chemotherapy. He achieved partial response (PR) at the 2nd course, but showed disease progressive (PD) at the 4th course. Then he received 2 courses of GDP regimen chemotherapy. Unfortunately, the patient died of tumor overload with hyper-lactacidemia 6 months after the onset of the disease. CONCLUSIONS: Lung biopsy is important to confirm a diagnosis of primary pulmonary lymphoma. Lung involvement in peripheral T cell lymphoma as a prognostic factor needs further studies.


Assuntos
Neoplasias Pulmonares/patologia , Pulmão/patologia , Linfoma de Células T Periférico/patologia , Acidose Láctica/induzido quimicamente , Acidose Láctica/complicações , Acidose Láctica/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Evolução Fatal , Humanos , Ácido Láctico/sangue , Pulmão/efeitos dos fármacos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/tratamento farmacológico , Linfoma de Células T Periférico/complicações , Linfoma de Células T Periférico/tratamento farmacológico , Masculino , Prednisolona/administração & dosagem , Prednisolona/efeitos adversos , Vincristina/administração & dosagem , Vincristina/efeitos adversos
11.
CEN Case Rep ; 8(4): 308-310, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31468344

RESUMO

The anion gap (AG) is a tool to diagnose metabolic acid-base disorders in the physiological approach to acid-base assessment. It is used to detect high AG acidosis, a type of metabolic acidosis caused by serum concentration increase in usually unmeasured anions; AG larger than the reference for it indicates the presence of high AG acidosis. This report presents a case of hyperlactatemia which was not detected as high AG acidosis possibly because of instrument error of a device in measurement of serum sodium and chloride concentrations. The case indicates that the error will make AG unable to detect high AG acidosis of any cause. Hence, upon suspicion of high AG acidosis caused by measurable anions such as lactate and ketones, it is recommended to measure their serum concentration.


Assuntos
Equilíbrio Ácido-Base/fisiologia , Acidose Láctica/diagnóstico , Acidose/diagnóstico , Erros de Diagnóstico/tendências , Acidose/sangue , Acidose Láctica/sangue , Idoso , Albuminas/análise , Albuminas/química , Bicarbonatos/sangue , Bicarbonatos/química , Análise Química do Sangue/instrumentação , Gasometria/instrumentação , Cloretos/sangue , Erros de Diagnóstico/estatística & dados numéricos , Eletrólitos/sangue , Eletrólitos/química , Feminino , Humanos , Ácido Láctico/sangue , Ácido Láctico/química , Sódio/sangue
13.
J Child Neurol ; 34(12): 778-781, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31282308

RESUMO

BACKGROUND: WARS2 encodes a tryptophanyl tRNA synthetase, which is involved in mitochondrial protein synthesis. Biallelic mutations in WARS2 are rare and have been associated with a spectrum of clinical presentations, including neurodevelopmental disorder with abnormal movements, lactic acidosis with or without seizures (NEMMLAS). CASE PRESENTATION: Here we present the case of an 8-year-old girl with ataxia and parkinsonism with periventricular white matter abnormalities on magnetic resonance imaging (MRI) and global developmental delay. The initial investigations revealed an elevated lactate level. Extensive metabolic testing, including a muscle biopsy, was inconclusive. Cerebrospinal fluid (CSF) neurotransmitter levels were low; however, a trial of levodopa was unremarkable. The chromosomal microarray and initial ataxia gene panel was normal. Zinc supplementation for a heterozygous variant of unknown significance in the CP gene on the ataxia exome panel was not effective in treating her symptoms. Reanalysis of the ataxia exome panel highlighted biallelic mutations in WARS2, which lead to the diagnosis of neurodevelopmental disorder, mitochondrial, with abnormal movements and lactic acidosis, with or without seizures (NEMMLAS). This lead to parental genetic testing, redirected therapy, and helped to expand the symptomology of this rare condition. CONCLUSION: Here we emphasize the importance of imminent and repeat expanded genetic testing to ensure early diagnosis and treatment for rare pediatric disorders. The patient is being trialed on a mitochondrial cocktail in an attempt to compensate for defects in mitochondrial protein synthesis associated with this variant. Longitudinal monitoring of disease manifestation will help establish the currently unknown natural history of this condition.


Assuntos
Acidose Láctica/diagnóstico , Discinesias/diagnóstico , Transtornos do Neurodesenvolvimento/diagnóstico , Convulsões/diagnóstico , Triptofano-tRNA Ligase/genética , Acidose Láctica/diagnóstico por imagem , Acidose Láctica/genética , Encéfalo/diagnóstico por imagem , Criança , Discinesias/diagnóstico por imagem , Discinesias/genética , Feminino , Humanos , Imagem por Ressonância Magnética , Mitocôndrias/genética , Transtornos do Neurodesenvolvimento/diagnóstico por imagem , Transtornos do Neurodesenvolvimento/genética , Fenótipo , Convulsões/diagnóstico por imagem , Convulsões/genética , Síndrome , Substância Branca/diagnóstico por imagem
14.
Basic Clin Pharmacol Toxicol ; 125(5): 466-473, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31215744

RESUMO

INTRODUCTION: The prevalence of type 2 diabetes (T2D) continues to rise across the world. Metformin is still considered the "gold standard" and is, therefore, increasingly prescribed. Monitoring of metformin continues to be debated because of its association with lactic acidosis (MALA), a rare but life-threatening complication. The aim of this study was to identify the main individual characteristics associated with severe poisoning in self-poisonings and therapeutic accidents reported at the Western France Poison Control Centre (PCC). METHODS: Retrospective study of metformin poisoning from September 1999 to September 2016 at the Western France PCC recorded in the French PCC's database (SICAP). The end-point was clinically high severity (mortality and/or cardiovascular shock and/or GCS ≤ 7/15). RESULTS: Of the 382 cases included, 197 concerned acute accidental exposures, 127 self-poisonings and 58 therapeutic accidents. MALA concerned 63 patients: 44 therapeutic accidents and 19 self-poisonings. High severity concerned 59 patients: 47 therapeutic accidents and 12 self-poisonings. T2D and age > 60 significantly increase the risk of high severity (OR 7.7, CI [1.54-38.41]; P = 0.013; OR 3.5, CI [1.60-7.84]; P = 0.002, respectively). CONCLUSIONS: Metformin may lead to MALA and severe poisoning in therapeutic accidents but also in self-poisoning circumstances. Among reported cases, T2D history and age >60 increase the risk of serious poisoning. Monitoring of their treatment should be taken seriously especially in the event of digestive symptoms such as diarrhoea.


Assuntos
Acidose Láctica/epidemiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Overdose de Drogas/epidemiologia , Hipoglicemiantes/envenenamento , Metformina/envenenamento , Acidose Láctica/induzido quimicamente , Acidose Láctica/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Análise de Dados , Bases de Dados Factuais/estatística & dados numéricos , Overdose de Drogas/diagnóstico , Overdose de Drogas/etiologia , Feminino , França/epidemiologia , Humanos , Hipoglicemiantes/administração & dosagem , Doença Iatrogênica/epidemiologia , Masculino , Metformina/administração & dosagem , Pessoa de Meia-Idade , Centros de Controle de Intoxicações/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
15.
Rev Neurol (Paris) ; 175(9): 564-567, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31053354

RESUMO

Although relatively common in children, severe acute lactic acidosis is rare in adults with mitochondrial myopathies. We report here three cases, aged 27, 32 and 32 years, who developed life-threatening metabolic crisis with severe lactic acidosis, requiring hospitalisation in intensive care unit. Plasma lactates were elevated 10 to 15 fold normal values, necessitating extra-renal dialysis. By contrast CK levels were moderately increased (3 to 5N). No triggering factor was identified, but retrospectively all patients reported long-lasting mild muscle fatigability and weakness before their acute metabolic crisis. All of them recovered after prolonged intensive care but resting lactate levels remained elevated. Muscle biopsy showed ragged-red and COX-negative fibers in two patients and mild lipidosis in the third one. Heteroplasmic pathogenic point mutations were detected in MT-TL1 (m.3280G>A;m.3258C>T) and MT-TK (m.8363A>G). Life-threatening lactic acidosis may thus be a major inaugural clinical manifestation in adults with mitochondrial myopathies. Prolonged intensive care may lead to a dramatic and sustained improvement and is mandatory in such cases.


Assuntos
Acidose Láctica/etiologia , Acidose Láctica/terapia , Cuidados Críticos , Doenças Mitocondriais/complicações , Doenças Mitocondriais/terapia , Acidose Láctica/diagnóstico , Adulto , Estado Terminal/terapia , Emergências , Feminino , Humanos , Masculino , Doenças Mitocondriais/diagnóstico , Doenças Mitocondriais/patologia , Estudos Retrospectivos
17.
Nat Commun ; 10(1): 1477, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30931947

RESUMO

Phenotypic and biochemical categorization of humans with detrimental variants can provide valuable information on gene function. We illustrate this with the identification of two different homozygous variants resulting in enzymatic loss-of-function in LDHD, encoding lactate dehydrogenase D, in two unrelated patients with elevated D-lactate urinary excretion and plasma concentrations. We establish the role of LDHD by demonstrating that LDHD loss-of-function in zebrafish results in increased concentrations of D-lactate. D-lactate levels are rescued by wildtype LDHD but not by patients' variant LDHD, confirming these variants' loss-of-function effect. This work provides the first in vivo evidence that LDHD is responsible for human D-lactate metabolism. This broadens the differential diagnosis of D-lactic acidosis, an increasingly recognized complication of short bowel syndrome with unpredictable onset and severity. With the expanding incidence of intestinal resection for disease or obesity, the elucidation of this metabolic pathway may have relevance for those patients with D-lactic acidosis.


Assuntos
Acidose Láctica/diagnóstico , Lactato Desidrogenases/genética , Ácido Láctico/metabolismo , Mutação com Perda de Função , Síndrome do Intestino Curto/metabolismo , Espasmos Infantis/diagnóstico , Acidose Láctica/genética , Adulto , Animais , Consanguinidade , Diagnóstico Diferencial , Homozigoto , Humanos , Lactente , Lactato Desidrogenases/deficiência , Masculino , Espasmos Infantis/genética , Peixe-Zebra
18.
Int Urol Nephrol ; 51(7): 1229-1230, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30963454

RESUMO

PURPOSE: To study the incidence of lactic acidosis due to metformin in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) stage 3-5. METHODS: We estimated plasma lactate in patients of CKD stage 3 and worse who were continuing metformin on their own prior to stopping the drug. RESULT: Of 40 patients included, median duration of T2DM was 60 months (interquartile range IQR 24-120). The mean serum creatinine was 309.4 ± 159.1 µmol/L and mean eGFR was 27.82 ± 12.93 mL/min/1.73 m2 with 3 (7.5%), 16 (40%), 11 (27.5%) and 10 (25%) in CKD stages 3a, 3b, 4 and 5, respectively. They were receiving metformin for a median duration of 24 months (IQR 12.5-60), an average dose of 896 ± 350 mg per day. The median of plasma lactate was 1.36 mmol/L (IQR 1.11-1.75 mmol/L) with three (7.5%) having levels above normal, two (20%) in CKD stage 5 and one (9.1%) in stage 4. CONCLUSION: Metformin can be safely used in CKD stage 3 and with regular measurement of plasma lactate in later stages.


Assuntos
Acidose Láctica , Diabetes Mellitus Tipo 2 , Ácido Láctico/sangue , Insuficiência Renal Crônica , Acidose Láctica/sangue , Acidose Láctica/induzido quimicamente , Acidose Láctica/diagnóstico , Acidose Láctica/prevenção & controle , Creatinina/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/metabolismo , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/métodos , Feminino , Taxa de Filtração Glomerular , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Masculino , Metformina/administração & dosagem , Metformina/efeitos adversos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Índice de Gravidade de Doença
19.
Diabetes Metab Syndr ; 13(1): 648-650, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641783

RESUMO

We present here a case of hypoglycemia and lactic acidosis in an elderly diabetic lady with underlying leukemia∖lymphoma. Possible mechanisms responsible for both hypoglycemia as well as lactic acidosis are discussed. The case emphasizes the need for thorough chasing of all clinical leads obtained from history taking, physical examination, as well as laboratory evaluation in order to avoid getting misled by apparently obvious diagnosis. To the best of the author's knowledge, this is the first time such a case is reported in Indian literature.


Assuntos
Acidose Láctica/diagnóstico , Diabetes Mellitus Tipo 2/complicações , Leucemia/complicações , Linfoma/complicações , Acidose Láctica/complicações , Idoso , Feminino , Humanos , Hipoglicemia/complicações , Hipoglicemia/diagnóstico
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