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Metformin Lactic Acidosis Mechanism

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Management Of Metformin-associated Lactic Acidosis By Continuous Renal Replacement Therapy

Abstract Metformin-associated lactic acidosis (MALA) is a severe metabolic failure with high related mortality. Although its use is controversial, intermittent hemodialysis is reported to be the most frequently used treatment in conjunction with nonspecific supportive measures. Our aim was to report the evolution and outcome of cases managed by continuous renal replacement therapy (CRRT). Methodology and Principal Findings Over a 3-year period, we retrospectively identified patients admitted to the intensive care unit for severe lactic acidosis caused by metformin. We included patients in our study who were treated with CRRT because of shock. We describe their clinical and biological features at admission and during renal support, as well as their evolution. We enrolled six patients with severe lactic acidosis; the mean pH and mean lactate was 6.92±0.20 and 14.4±5.1 mmol/l, respectively. Patients had high illness severity scores, including the Simplified Acute Physiology Score II (SAPS II) (average score 63±12 points). Early CRRT comprised either venovenous hemofiltration (n = 3) or hemodiafiltration (n = 3) with a mean effluent flow rate of 34±6 ml/kg/h. Metabolic acidosis con Continue reading >>

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Popular Questions

  1. joanne c(414)

    Urine result

    My 2 year old has been poorly for a few days with a high temp.
    Today she started crying that the bottom of her tummy was sore do i decided to take her to the walk in centre to be looked over.
    A nurse asked for a urine sample which i managed to get a clean catch (as they called it with dd sat on toilet and clean plastic cup under her while she went).
    They then put the urine in a machine and the nurse gave me the results to show the doctor when we were called to see her.
    The results said
    Pro trace
    Ketones 3.9
    Lev cal 500 leu/ul
    She has been given antibs for a suspected water infection and i have to take another sample in on monday.
    I was just wondering what all the above results mean.

  2. Laura S(1188)

    Hello results like that just usually mean that there is a germ found in the urine. I have suffered from water infections since I was little girl so I have regularly been on antibiotics for them. In fact I'm 12 weeks pregnant and on antibiotics for them now.. I would say just keep an eye on it and after she finishes the course take another urine sample in an ask for it to be tested again to make sure the infection is def gone.. the main cause of infections like this is not using the tissue the right way after using the toilet i.e. from front to back or not drinking enough water. Mine are caused through not drinking enough water and I dont even get the symtoms anymore but in her case its not to much to worry about xx

  3. joanne c(414)

    My dd drinks loads and she is still in nappys.
    What i was a bit worried about was the ketones in her urine, she has been eating ( not as much as normal but this morning before we went to get her looked at she had shreddies and two yougerts).
    Is ketones of 3.9 normal with a urine infection?

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