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1.
BMJ Case Rep ; 12(7)2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31350229

RESUMO

While potassium cyanide poisoning has been well described, the toxicity of potassium gold cyanide is less well understood. This case describes an 84-year-old man who presented after an intentional ingestion of 0.5-1 teaspoons of potassium gold cyanide. Despite antidotal therapy, the patient rapidly developed severe lactic acidosis, multiorgan dysfunction and ultimately expired. While the patient's clinical findings were consistent with acute cyanide poisoning, a serum cyanide level was below the toxic threshold. Previous reports have suggested that gold toxicity may also contribute to the effects of potassium gold cyanide, and may have played a role in the patient's rapid decline. In addition to treatment of cyanide toxicity, management of acute gold toxicity should also be considered in potassium gold cyanide ingestion.


Assuntos
Acidose Láctica/induzido quimicamente , Cianatos/envenenamento , Compostos de Ouro/envenenamento , Ouro/envenenamento , Cianeto de Potássio/envenenamento , Suicídio , Idoso de 80 Anos ou mais , Humanos , Masculino
2.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 44(6): 714-719, 2019 Jun 28.
Artigo em Chinês | MEDLINE | ID: mdl-31304935

RESUMO

The incidence of telbivudine-related adverse reactions has been gradually increased. The increased levels of muscle enzymes and blood lactate are common. In this case, a 23-year-old male patient with long-term oral telbivudine had a rare serious adverse reaction. The main clinical manifestations were progressive myalgia, gradually progressed to mental disorder, and together with multiple organ dysfunction, in which the level of blood lactate was increased significantly and metabolic acidosis was extremely severe. Blood purification and sodium bicarbonate were given to correct acidosis, while ceftazidime was used to prevent infection. Telbivudine was discontinued, and tenofovir disoproxil fumarate and liver protective drug were used. The patient was discharged with a better health condition. Such patients are easily misdiagnosed as neuromuscular diseases in the early stage, which might delay the treatment and worsen medical conditions. Clinicians need to be cautious and obtain an early identification to avoid misdiagnosis.


Assuntos
Acidose Láctica , Telbivudina/efeitos adversos , Acidose Láctica/induzido quimicamente , Evolução Fatal , Humanos , Masculino , Insuficiência de Múltiplos Órgãos , Adulto Jovem
3.
Pan Afr Med J ; 32: 112, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223402

RESUMO

Metformin is a commonly used treatment modality in type 2 diabetes mellitus with lactic acidosis as a rare but life-threatening side effect. In this case report we highlight the importance of recognizing this uncommon side effect and the treatment options in a resource limited situation. We present a 14-year-old African girl who ingested an unknown amount of metformin intentionally after an argument with her mother. She was referred late to our institution in severe lactic acidosis. Lactic acidosis resolved with appropriate treatment including peritoneal dialysis. We conclude that in resource constrained settings, peritoneal dialysis may be used for metformin associated lactic acidosis with favourable outcome.


Assuntos
Acidose Láctica/induzido quimicamente , Hipoglicemiantes/envenenamento , Metformina/envenenamento , Diálise Peritoneal/métodos , Acidose Láctica/terapia , Adolescente , Feminino , Humanos , Resultado do Tratamento
4.
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 , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Índice de Gravidade de Doença
5.
Chest ; 155(3): e75-e77, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30846078

RESUMO

CASE PRESENTATION: A 35-year-old woman presented with 2 days of nausea, abdominal pain, and fatigue. On the day of presentation, her abdominal pain worsened, she developed progressive somnolence, and had several bouts of nonbloody, nonbilious emesis. She denied prior headache, rashes, and toxic or illicit ingestions. The patient had a medical history of diabetes mellitus type 2, hyperlipidemia, and mild cognitive delay (highly functional, maintaining a job, home, and medication responsibilities). She reported taking only simvastatin and short-acting insulin. She had an unknown adverse reaction to metformin. She was a nonsmoker and denied history of drug and alcohol use.


Assuntos
Acidose Láctica , Diabetes Mellitus Tipo 2/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Metformina/efeitos adversos , Administração dos Cuidados ao Paciente/métodos , Choque , Dor Abdominal , Acidose Láctica/sangue , Acidose Láctica/induzido quimicamente , Acidose Láctica/fisiopatologia , Acidose Láctica/terapia , Adulto , Diabetes Mellitus Tipo 2/diagnóstico , Diagnóstico Diferencial , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/fisiopatologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Hipotermia/etiologia , Hipotermia/terapia , Metformina/administração & dosagem , Respiração Artificial/métodos , Ressuscitação/métodos , Choque/diagnóstico , Choque/etiologia , Choque/terapia , Sonolência , Resultado do Tratamento , Vasoconstritores/administração & dosagem
6.
In Vivo ; 33(2): 563-565, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30804142

RESUMO

BACKGROUND/AIM: Recent advances in chemotherapy have increased the possibility of conversion hepatectomy for patients with initially unresectable liver metastases. Although long-term chemotherapy and subsequent extensive hepatectomy are becoming more common, the toxicities of such chemotherapies are unclear. PATIENTS AND METHODS: We present a case report of a patient with metastatic colorectal cancer who developed severe encephalopathy with lactic acidosis and hyperammonaemia caused by 5-fluorouracil-based chemotherapy. Administration of vitamin B1 and continuous haemodiafiltration rapidly improved the patient's symptoms. CONCLUSION: Intensive treatment of metastatic colorectal cancer patients with 5-fluorouracil can induce rare adverse events.


Assuntos
Acidose Láctica/patologia , Encefalopatias/patologia , Neoplasias Colorretais/tratamento farmacológico , Hiperamonemia/patologia , Acidose Láctica/induzido quimicamente , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Encefalopatias/induzido quimicamente , Camptotecina/efeitos adversos , Camptotecina/análogos & derivados , Neoplasias Colorretais/complicações , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Feminino , Fluoruracila/efeitos adversos , Hepatectomia , Humanos , Hiperamonemia/induzido quimicamente , Leucovorina/efeitos adversos , Metástase Neoplásica , Receptores de Fatores de Crescimento do Endotélio Vascular , Proteínas Recombinantes de Fusão/efeitos adversos
7.
Rev Med Suisse ; 15(639): 422-426, 2019 Feb 20.
Artigo em Francês | MEDLINE | ID: mdl-30785674

RESUMO

Metformin is the first line therapy for patients with diabete type 2. However, the molecule is known to be responsible for lactic acidosis through its inhibition of the mitochondrial respiratory chain complex, a pathology called MALA (metformin associated lactic acidosis). This complication has been widely discussed in the literature because its development is usually the result of a multifactorial and complex process. As the mortality of MALA is potentially high, a good knowledge of the physiopathology, existing treatments and predisposing factors is necessary for the primary care physician.


Assuntos
Acidose Láctica , Diabetes Mellitus Tipo 2 , Hipoglicemiantes , Metformina , Acidose Láctica/induzido quimicamente , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos
8.
Nefrología (Madrid) ; 39(1): 35-43, ene.-feb. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-181907

RESUMO

Objetivos: Conocer la incidencia de casos de acidosis láctica por metformina durante el periodo enero de 2014 y marzo de 2017 en el Área Sanitaria III de Aragón. Analizar los factores clínicos y analíticos asociados y la mortalidad. Resultados: Treinta y un casos (61,3% varones). Incidencia: 79,76 casos/100000 pacientes-año; edad media 75,39 ± 9,34 años; 23 de ellos con niveles séricos de metformina (21,91 ± 15,52 mcg / mL); miligramos/día de metformina ingeridos: 1790,32 ± 499; 96,8% de casos en el contexto de fracaso renal agudo; 11 casos con antecedentes de enfermedad renal crónica (35,5%); 12 requirieron UCI (38,7%); 13 requirieron tratamiento depurador (41,9%; 3 hemodiafiltración, 10 hemodiálisis) Existió correlación significativa entre: miligramos diarios ingeridos de metformina y niveles del fármaco; niveles de metformina y: creatinina pico, pH y lactato. La mortalidad fue del 25,8%. Solo hubo diferencias significativas entre los fallecidos y los supervivientes respecto a la duración de la estancia y la creatinina final. La regresión logística multivariante no detectó ninguna variable del estudio asociada con la mortalidad. Conclusiones: La incidencia en nuestra área sanitaria es más elevada que en otras series, con 25,8% de mortalidad. Prácticamente todos los casos en el contexto de fracaso renal agudo de origen prerrenal. En un 29% de los casos hubo sobredosificación. Es necesario advertir a los pacientes de las situaciones más frecuentes potencialmente inductoras de acidosis láctica, especialmente la deshidratación, si siguen tomando el fármaco durante las mismas


Objectives: To determine the incidence of metformin-induced lactic acidosis during the period January 2014 to March 2017 in Aragon Healthcare Area III. To analyse the associated clinical and analytical factors and mortality. Results: A total of 31 cases (61.3% males). Incidence: 79.76 cases/100,000 patients-year; mean age 75.39±9.34 years; 23 of them with levels of serum metformin (21.91 ± 15.52 mcg/ ml); milligrams/day of metformin ingested: 1790.32 ± 499; 96.8% of cases in the context of acute kidney failure; 11 cases with a history of chronic kidney disease (35.5%); 12 required intensive care (38.7%); 13 required purification treatment (41.9%; 3 haemodiafiltration, 10 haemodialysis). There was a significant correlation between daily milligrams of metformin ingested and drug levels; levels of metformin; and peak creatinine, pH and lactate. Mortality was 25.8%. There were only significant differences between the deceased and survivors regarding the duration of stay and final creatinine. Multivariate logistic regression did not detect any study variables associated with mortality. Conclusions: The incidence in our healthcare area is higher than in other series, with a 25.8% mortality rate. Virtually all cases were in the context of prerenal acute kidney failure. In 29% of cases, there was an overdose. Patients must be warned about the most common lactic acidosis-inducing situations, especially dehydration, if they continue taking the drug at such times


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Acidose Láctica/induzido quimicamente , Acidose Láctica/mortalidade , Metformina/efeitos adversos , Atenção Terciária à Saúde , Fatores de Risco , Espanha/epidemiologia , Incidência
10.
Nefrologia ; 39(1): 35-43, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30060893

RESUMO

OBJECTIVES: To determine the incidence of metformin-induced lactic acidosis during the period January 2014 to March 2017 in Aragon Healthcare Area III. To analyse the associated clinical and analytical factors and mortality. RESULTS: A total of 31 cases (61.3% males). Incidence: 79.76 cases/100,000 patients-year; mean age 75.39±9.34 years; 23 of them with levels of serum metformin (21.91±15.52 mcg/ ml); milligrams/day of metformin ingested: 1790.32±499; 96.8% of cases in the context of acute kidney failure; 11 cases with a history of chronic kidney disease (35.5%); 12 required intensive care (38.7%); 13 required purification treatment (41.9%; 3 haemodiafiltration, 10 haemodialysis). There was a significant correlation between daily milligrams of metformin ingested and drug levels; levels of metformin; and peak creatinine, pH and lactate. Mortality was 25.8%. There were only significant differences between the deceased and survivors regarding the duration of stay and final creatinine. Multivariate logistic regression did not detect any study variables associated with mortality. CONCLUSIONS: The incidence in our healthcare area is higher than in other series, with a 25.8% mortality rate. Virtually all cases were in the context of prerenal acute kidney failure. In 29% of cases, there was an overdose. Patients must be warned about the most common lactic acidosis-inducing situations, especially dehydration, if they continue taking the drug at such times.


Assuntos
Acidose Láctica/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Acidose Láctica/epidemiologia , Acidose Láctica/mortalidade , Acidose Láctica/terapia , Idoso , Feminino , Humanos , Hipoglicemiantes/administração & dosagem , Incidência , Modelos Logísticos , Masculino , Metformina/administração & dosagem , Distribuição por Sexo , Espanha/epidemiologia , Centros de Atenção Terciária
11.
Basic Clin Pharmacol Toxicol ; 124(1): 105-114, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30267605

RESUMO

Metformin pharmacokinetics (PK) is highly variable, and researchers have for years tried to shed light on determinants of inter-individual (IIV) and inter-occasion variability (IOV) of metformin PK. We set out to identify the main sources of PK variability using a semi-mechanistic model. We assessed the influence of subject characteristics, including seven genetic variants. Data from three studies of healthy individuals with PK measurements of plasma and urine after single dose or at steady-state were used in this study. In total, 87 subjects were included (16 crossover subjects). Single nucleotide polymorphisms in ATM, OCT1, OCT2, MATE1 and MATE2-K were investigated as dominant, recessive or additive. A three-compartment model with transit absorption and renal elimination with a proportional error was fitted to the data using NONMEM 7.3. Oral parameters were separated from disposition parameters as dose-dependent absolute bioavailability was determined with support from urine data. Clearance was expressed as net renal secretion and filtration, assuming full fraction unbound and fraction excreted. Mean transit time and peripheral volume of distribution were identified as the main sources of variability according to estimates, with 94% IOV and 95% IIV, respectively. Clearance contributed only with 16% IIV. Glomerular filtration rate and body-weight were the only covariates found to affect metformin net secretion, reducing IIV to 14%. None of the genetic variants were found to affect metformin PK. Based on our analysis, finding covariates explaining absorption of metformin is much more valuable in understanding variability and avoiding toxicity than elimination.


Assuntos
Variação Biológica Individual , Variação Biológica da População/fisiologia , Hipoglicemiantes/farmacocinética , Metformina/farmacocinética , Modelos Biológicos , Acidose Láctica/induzido quimicamente , Acidose Láctica/prevenção & controle , Administração Oral , Adulto , Disponibilidade Biológica , Ensaios Clínicos como Assunto , Absorção Gastrointestinal/fisiologia , Trânsito Gastrointestinal/fisiologia , Voluntários Saudáveis , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Metformina/administração & dosagem , Metformina/efeitos adversos , Pessoa de Meia-Idade , Proteínas de Transporte de Cátions Orgânicos/genética , Variantes Farmacogenômicos , Polimorfismo de Nucleotídeo Único , Fatores de Tempo , Adulto Jovem
12.
BMJ Case Rep ; 11(1)2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30567126

RESUMO

Older patients with type 2 diabetes are prone to developing adverse events with aggressive antihyperglycaemic therapy. Metformin-associated lactic acidosis (MALA) is one such rare, life-threatening adverse drug effect. We report the case of a 70-year-old man with a glycated haemoglobin of 7.9% who was on a stable, maximally tolerated dose of metformin for managing his type 2 diabetes. He was initiated on liraglutide injections with hopes to achieve better glycaemic control, but developed unrelenting nausea and vomiting during the third week of treatment. He presented to the hospital with these symptoms and was noted to have severe MALA. He sustained an in-hospital cardiac arrest requiring emergent resuscitation along with vasopressor and mechanical ventilator support. He underwent continuous venovenous haemodiafiltration to remove metformin and correct the acidosis, following which he stabilised and supportive therapy was weaned off. He was discharged from the hospital on insulin therapy with incomplete renal recovery.


Assuntos
Acidose Láctica/induzido quimicamente , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/efeitos adversos , Liraglutida/efeitos adversos , Acidose Láctica/diagnóstico , Idoso , Glicemia/efeitos dos fármacos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Hemoglobina A Glicada/análise , Parada Cardíaca/induzido quimicamente , Hemodiafiltração/métodos , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Doença Iatrogênica , Insulina/uso terapêutico , Liraglutida/administração & dosagem , Liraglutida/uso terapêutico , Masculino , Metformina/efeitos adversos , Resultado do Tratamento
13.
Indian J Pharmacol ; 50(4): 212-214, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30505059

RESUMO

Highly active antiretroviral therapy (HAART) is nowadays universally available to patients with HIV/AIDS. This has led to increased longevity in people living with HIV/AIDS. However, these patients frequently face chronic and rarely acute life-threatening complications of HAART. Herein, we report the case of a patient who was on HAART and developed zidovudine-induced lactic acidosis, acute pancreatitis, and myopathy. Although these acute complications are rare, a high index of suspicion is required for early diagnosis and to reduce significant morbidity and mortality.


Assuntos
Acidose Láctica/induzido quimicamente , Doenças Musculares/induzido quimicamente , Pancreatite/induzido quimicamente , Zidovudina/efeitos adversos , Acidose Láctica/diagnóstico , Doença Aguda , Adulto , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/efeitos adversos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Doenças Musculares/diagnóstico , Pancreatite/diagnóstico , Zidovudina/administração & dosagem
14.
Medicine (Baltimore) ; 97(36): e12114, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30200095

RESUMO

BACKGROUND: In recent years, linezolid is increasingly used in multidrug-resistant bacteria therapy. At the same time, linezolid-induced lactic acidosis has been continually reported as a serious side effect. Notably, to our knowledge, there are limited available literatures that evaluate risk factors for linezolid-induced lactic acidosis, and there is no highly reliable study on the relationship between linezolid-induced lactic acidosis and age or gender. However, clinicians need relevant information to advice on the use of linezolid. Therefore, we report on a case of life-threatening lactic acidosis after 3 doses of linezolid exposure and evaluate the risk factors of linezolid-induced lactic acidosis. METHODS: Cases of linezolid-induced lactic acidosis reported in PubMed were searched. Several characteristics and data of case numbers and deaths were extracted for analysis. RESULTS: A total of 35 articles including 47 cases were included in this study. Twelve patients (25.5%) died due to linezolid-induced lactic acidosis. At the cut-offs of 7, 14, and 28 days, the mortalities were 27.3%, 20%, and 27.3%. No statistically significant difference was observed according to age and gender. However, the proportion (27.7% and 29.8%) and mortality (30.8% and 35.7%) of male patients were much higher than females in both ≥65 and <65 years old groups (proportion: 15.2% and 23.9%; mortality: 14.3% and 18.2%). CONCLUSION: The mortality of linezolid-induced lactic acidosis was relatively high. The duration of linezolid use and age might not be risk factors. Gender (specifically, male) might be related to the mortality of linezolid-induced lactic acidosis.


Assuntos
Acidose Láctica/induzido quimicamente , Antibacterianos/efeitos adversos , Linezolida/efeitos adversos , Acidose Láctica/mortalidade , Antibacterianos/uso terapêutico , Evolução Fatal , Humanos , Linezolida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Fatores de Risco
15.
G Ital Nefrol ; 35(5)2018 Sep.
Artigo em Italiano | MEDLINE | ID: mdl-30234235

RESUMO

Metformin is an antidiabetic drug; used to treat type II diabetes mellitus, metformin associated lactic acidosis has an incidence of 2-9 cases / 100,000 patients / year with high mortality (30%). We have had the case of a 75-year-old woman with metabolic acidosis as a result of metformin assumption, treated by renal replacement therapy (CRRT) with continuous veno-venous hemodiafiltration (CVVHDF). RESULTS: after a short treatment period there was a reduction in Lactates (from 16.8 mmol/L to 12.6 mmol/L) and a progressive improvement of acidosis. In 72 hours the recovery of diuresis and subsequent suspension of CRRT was achieved. CONCLUSION: CRRT, in addition to ensuring support for renal failure and volume correction, allowed a rapid recovery from metformin-associated lactic acidosis.


Assuntos
Acidose Láctica/induzido quimicamente , Anticoagulantes/uso terapêutico , Hemodiafiltração , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Citrato de Sódio/uso terapêutico , Acidose Láctica/complicações , Acidose Láctica/tratamento farmacológico , Idoso , Espasmo Brônquico/etiologia , Terapia Combinada , Feminino , Furosemida/uso terapêutico , Humanos , Hipotensão/etiologia , Combinação Piperacilina e Tazobactam/uso terapêutico , Bicarbonato de Sódio/uso terapêutico
16.
Am J Case Rep ; 19: 1117-1120, 2018 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-30232318

RESUMO

BACKGROUND Linezolid (LZD) has been reported to combat several intractable infectious diseases, including multidrug-resistant infections and tuberculosis. Although quite a number of adverse effects of LZD therapy have been abundantly described so far, LZD associated lactic acidosis and thrombocytopenia have rarely been studied. We described a patient dying of lactic acidosis and thrombocytopenia associated with LZD therapy complications. To the best of our knowledge, this is the first report focusing on LZD therapy complications in treating patients with deadly abnormalities in hemogram. CASE REPORT A 50-year-old Chinese female was diagnosed with endocarditis and thus received LZD therapy for 25 days, then complained about 6 days' abdominal pain and vomiting before being admitted to the Emergency Department. Upon admission, lactic acidosis and thrombocytopenia were immediately observed. CONCLUSIONS Physicians should be aware of typical clinical manifestations of lactic acidosis related to LZD exposure, since this complication might be a life-threatening metabolic emergency.


Assuntos
Acidose Láctica/induzido quimicamente , Antibacterianos/efeitos adversos , Endocardite Bacteriana/tratamento farmacológico , Linezolida/efeitos adversos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/tratamento farmacológico , Trombocitopenia/induzido quimicamente , Antibacterianos/uso terapêutico , Evolução Fatal , Feminino , Humanos , Linezolida/uso terapêutico , Pessoa de Meia-Idade
17.
Biomed Pharmacother ; 106: 1760-1766, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30119251

RESUMO

The application of iodinated contrast medium has become a risk factor for metformin-associated lactic acidosis (MALA), which leads to the accumulation of metformin in vivo is one of the principal reasons for MALA. However, the molecular mechanism of the adverse event is not yet clear. In this study, iohexol injection was used as a model drug. The contrast agent acute kidney injury rat model, in vivo rat pharmacokinetic study, kidney slices and HK-2 cells were performed to elucidate the pharmacokinetic molecular mechanism of accumulation of metformin caused by contrast-induced nephropathy (CIN). Plasma exposure of metformin was increased significantly in the CIN group compared with that in the normal and control groups. The AUC of metformin was from 2791 ±â€¯382 µg min mL-1 to 4784 ±â€¯767 µg min mL-1. The cumulative urinary excretion of metformin was also reduced in the CIN group. The uptake of metformin decreased in kidney slices in the CIN group. Compared with the normal and control groups, the blood lactate concentration was increased after intravenous administration of metformin in the CIN group followed a similar trend to the plasma concentrations of metformin. After treatment with contrast medium, the expression of OCT2 was reduced in rat kidney and HK-2 cells. These findings highlight that OCT2 deficiency was associated with increased lactate levels during metformin treatment caused by CIN.


Assuntos
Acidose Láctica/induzido quimicamente , Lesão Renal Aguda/metabolismo , Meios de Contraste , Hipoglicemiantes/toxicidade , Iohexol , Túbulos Renais Proximais/efeitos dos fármacos , Ácido Láctico/sangue , Metformina/toxicidade , Transportador 2 de Cátion Orgânico/metabolismo , Acidose Láctica/sangue , Acidose Láctica/fisiopatologia , Lesão Renal Aguda/induzido quimicamente , Animais , Linhagem Celular , Modelos Animais de Doenças , Hipoglicemiantes/farmacocinética , Técnicas In Vitro , Túbulos Renais Proximais/metabolismo , Túbulos Renais Proximais/fisiopatologia , Masculino , Metformina/farmacocinética , Ratos Wistar , Regulação para Cima
18.
J Med Case Rep ; 12(1): 223, 2018 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-30119705

RESUMO

BACKGROUND: Metformin toxicity is well known to cause lactic acidosis. Multiple cases of hypoglycemia due to isolated metformin overdose have been reported. Increased glucose consumption secondary to anaerobic metabolism has been reported as a possible explanation. CASE PRESENTATION: A 23-year-old Arabic woman took 30 g of metformin. In the emergency department, 4 hours after of the event, she was fatigued but vitally stable. During her hospitalization, she had severe lactic acidosis, hypotension corrected with fluid boluses and vasopressors, and multiple episodes of hypoglycemia (6.3 mg/dL, 38 mg/dL, and 42 mg/dL), requiring multiple 50% dextrose-water boluses. The three hypoglycemic episodes occurred coincident with severe lactic acidosis. She improved after 24 hours of continuous renal replacement therapy. CONCLUSIONS: Hypoglycemia can be induced by metformin toxicity in the absence of co-ingestants. A possible explanation of metformin-induced hypoglycemia is increased glucose consumption due to anaerobic metabolism, decreased oral intake, decreased liver glucose production, and decreased glucose absorption.


Assuntos
Fármacos Antiobesidade/efeitos adversos , Hipoglicemia/induzido quimicamente , Metformina/efeitos adversos , Síndrome do Ovário Policístico/tratamento farmacológico , Tentativa de Suicídio , Acidose Láctica/induzido quimicamente , Acidose Láctica/terapia , Feminino , Humanos , Hipoglicemia/terapia , Recidiva , Adulto Jovem
20.
Transpl Infect Dis ; 20(5): e12960, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29975806

RESUMO

Fatal lactic acidosis has been reported while on the treatment with Nucleoside/nucleotide analogues (NA) for the treatment of hepatitis B, C and HIV. No cases of such a complication have been reported in hematopoietic stem cell transplant (HSCT) recipients. We present a 65-year male who underwent autologous HSCT for the treatment of multiple myeloma. Prior to transplant he was started on single agent tenofovir alafenamide (TAF) for treatment of resolved hepatitis B infection. He presented few weeks later with severe lactic acidosis. Other causes of lactic acidosis were excluded. The patient died of multi-organ failure despite stopping TAF and aggressive supportive care. The case demonstrates the need for increased awareness of this potential complication of NA treatment in the course of transplantation.


Assuntos
Acidose Láctica/induzido quimicamente , Adenina/análogos & derivados , Antivirais/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Adenina/efeitos adversos , Idoso , Evolução Fatal , Infecções por HIV/tratamento farmacológico , Hepatite B/tratamento farmacológico , Hepatite C/tratamento farmacológico , Humanos , Masculino , Mieloma Múltiplo/cirurgia , Transplante Autólogo/efeitos adversos
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