Metformin Lactic Acidosis Mechanism

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Acute kidney injury (also called acute renal failure) nursing NCLEX review lecture on the nursing management, stages, pathophysiology, and causes (prerenal, intrarenal, postrenal). What is Acute Kidney Injury? It is the SUDDEN decrease in renal function that leads to the build up of waste in the blood, fluid overload, and electrolyte imbalances. What are the causes of Acute Kidney Injury? There are three causes, which are based on location. The first is known as prerenal injury and this is an issue with the perfusion to the kidneys that leads to decreased renal function. A second cause is known as intrarenal injury, and this is due to damage to the nephrons of the kidney. Lastly, postrenal injury is due to a blockage located in the urinary tract after the kidney that can extend to the urethra. This is causing the back flow of urine, which increases the pressure and waste in the kidneys. Stages of Acute Kidney Injury: There are four stage of acute kidney injury, which include initiation, oliguric, diuresis, and recovery stage. The initiation stage starts when a cause creates an injury to the kidney and then signs and symptoms start to appear. This leads to the oliguric stages. The patient will void less than 400 mL/day of urine during this stage and will experience increased BUN/creatinine levels, azotemia, hyperkalemia, hypervolemia, increase phosphate and decreased calcium levels along with metabolic acidosis. After this stage the patient can progress to the diuresis stage and this is where the patient will void 3-6 Liters of urine per day due to osmotic diuresis. The patient is at risk for hypokalemia, dehydration, and hypovolemia. The last stage is recovery and the patient's glomerular filtration rate has returned to normal. Therefore, the kidneys are able to maintain normal BUN and creatinine levels, electrolyte, and water levels. Quiz on Acute Kidney Injury: http://www.registerednursern.com/acut... Notes: http://www.registerednursern.com/acut... More NCLEX Renal Lectures: https://www.youtube.com/playlist?list... Subscribe: http://www.youtube.com/subscription_c... Nursing School Supplies: http://www.registerednursern.com/the-... Visit our website RegisteredNurseRN.com for free quizzes, nursing care plans, salary information, job search, and much more: http://www.registerednursern.com Check out other Videos: https://www.youtube.com/user/Register... All of our videos in a playlist: https://www.youtube.com/watch?v=pAhHx... Popular Playlists: NCLEX Reviews: https://www.youtube.com/playlist?list... Fluid & Electrolytes: https://www.youtube.com/playlist?list... Nursing Skills: https://www.youtube.com/playlist?list... Nursing School Study Tips: https://www.youtube.com/playlist?list... Nursing School Tips & Questions" https://www.youtube.com/playlist?list... Teaching Tutorials: https://www.youtube.com/playlist?list... Types of Nursing Specialties: https://www.youtube.com/playlist?list... Healthcare Salary Information: https://www.youtube.com/playlist?list... New Nurse Tips: https://www.youtube.com/playlist?list... Nursing Career Help: https://www.youtube.com/playlist?list... EKG Teaching Tutorials: https://www.youtube.com/playlist?list... Dosage & Calculations for Nurses: https://www.youtube.com/playlist?list... Diabetes Health Managment: https://www.youtube.com/playlist?list...

Metformin-associated Acute Kidney Injury And Lactic Acidosis

Copyright © 2011 David Arroyo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Objectives. Metformin is the preferred oral antidiabetic agent for type 2 diabetes. Lactic acidosis is described as a rare complication, usually during an acute kidney injury (AKI). Material and Methods. We conducted a prospective observational study of metformin-associated AKI cases during four years. 29 cases were identified. Previous renal function, clinical data, and outcomes were recorded. Results. An episode of acute gastroenteritis precipitated the event in 26 cases. Three developed a septic shock. Three patients died, the only related factor being liver dysfunction. More severe metabolic acidosis hyperkalemia and anemia were associated with higher probabilities of RRT requirement. We could not find any relationship between previous renal dysfunction and the outcome of the AKI. Conclusions. AKI associated to an episode of volume depletion due to gastrointestinal losses is a serious complication in type 2 diabetic pati Continue reading >>

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  1. person011

    For someone in DKA, what blood gas is more likely?
    PH 7.05 PO2 110 PCO2 20
    PH 7.10 PO2 90 PCO2 65
    PH 7.40 PO2 100 PCO2 20
    I am thinking it is the first one, but wanted to make sure

  2. ksmi117

    First one. Have to be acidotic so not 3. Since it's a metabolic acidosis, the body will attempt to compensate with a respiratory alkalosis (hyperventilation to breath off CO2) so the pCO2 should be low as well. Since the pH is less than 7.1, it'd be considered severe DKA.
    Two is an example of respiratory acidosis, as the patient is retaining CO2 and thus becoming more acidotic.
    Three is likely a mixed metabolic acidosis and respiratory alkalosis (not compensatory since the pH is normal here), like aspirin overdose. I suppose this could also be the ABG of someone with DKA and a concurrent primary respiratory alkalosis, though this is not as likely as the first ABG for a patient in DKA.

  3. Top Gun

    The first ABG is most consistent with DKA. The second suggests a primary respiratory acidosis, like in a COPDer, and the third suggests a mixed disorder. Also, another key thing to look for with DKA is an elevated anion gap.

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Anion gap usmle - anion gap metabolic acidosis normal anion gap metabolic acidosis

Metformin-induced Lactic Acidosis With Emphasis On The Anion Gap

Metformin-induced lactic acidosis with emphasis on the anion gap We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Proceedings (Baylor University. Medical Center) Metformin-induced lactic acidosis with emphasis on the anion gap Britton Blough, MD, Amber Moreland, MD, and Adan Mora, Jr., MD The presence of an anion gap in a diabetic patient, especially if associated with evidence of compromised renal function, should prompt clinicians to consider metformin as a contributing factor. This consideration is especially important in patients with severe anion gaps associated with lactic acidosis out of proportion to the patient's clinical presentation. Measurement of serum electrolytes and determination of acid-base status is beyond routine in today's clinical practice. The importance of recognizing and treating disturbances in normal physiology can Continue reading >>

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  1. spage_rn

    I have smelled sinus infections like that, but I would definitely keep the appt with the doctor!
    Quote from spage_rn
    Nurses...I am so glad I found this web site (thanks Jeeves!). Anyway, my husband's breath smells like moth balls. Yes, it is disgusting. I am making him an appt at the internist tomorrow. This has been going on since Thursday...poor guy has brushed, flossed, scrubbed and used listerine like crazy. He feels fine.
    I guess I am asking if you all can think of some reason for this!! I have looked and looked on line and in the Merck Manual. All I find is acetone smelling breath for ketosis. And his breath smells like an old man...reminds me of my father in law (66, had prostate cancer 5 years ago). Help!! My husband has no s/sx of diabetes. I have even done finger sticks...always less than 110.
    He had this happen about a year ago but we can't remember what or when it went away.
    thanks for any help or insight.

  2. CDN_NPtobe

    Any problems with urination? Sometimes kidney failure will cause people to be malodorous because its a way for the body to try and rid itself of toxins. He also may have a pharygeal pouch or something that is filling with food that could cause the odor.
    Just ideas--I would agree that he should keep his appointment. Let us know how he makes out...

  3. LydiaGreen

    There are many possibilities so the appointment should definitely be kept. Could be a sinus infection. Does he have any trouble sleeping? Excessive snoring, periods where he stops breathing? My daughter has enlarged adenoids (possible T&A surgery this month) and it doesn't matter how often she brushes, flosses, gargles - she still has bad breath (although, she isn't aware of it - we've never told her. She's seven and the poor kid has more than enough to worry about with the lack of sleep.)

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in this videoclip dr. Pietro Addamo and dr Simona Polemi illustrate metabolic and pathophysiological pathways that lead to lactic acidosis caused by metformin. The short video ends with a case report.

Metformin And Fatal Lactic Acidosis

Publications Published: July 1998 Information on this subject has been updated. Read the most recent information. Dr P Pillans,former Medical Assessor, Centre for Adverse Reactions Monitoring (CARM), Dunedin Metformin is a useful anti-hyperglycaemic agent but significant mortality is associated with drug-induced lactic acidosis. Significant renal and hepatic disease, alcoholism and conditions associated with hypoxia (eg. cardiac and pulmonary disease, surgery) are contraindications to the use of metformin. Other risk factors for metformin-induced lactic acidosis are sepsis, dehydration, high dosages and increasing age. Metformin remains a major reported cause of drug-associated mortality in New Zealand. Of the 12 cases of lactic acidosis associated with metformin reported to CARM since 1977, 2 occurred in the last year and 8 cases had a fatal outcome. Metformin useful but small risk of potentially fatal lactic acidosis Metformin is a useful therapeutic agent for obese non-insulin dependent diabetics and those whose glycaemia cannot be controlled by sulphonylurea monotherapy. Lactic acidosis is an uncommon but potentially fatal adverse effect. The reported frequency of lactic acidos Continue reading >>

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  1. TineCiel

    I lost a lot of hair from the third month in to the 7th. Now it has pretty much gone back to normal. I started taking magnesium and biotin supplements around month 6...

  2. koririko

    I'm currently in month 4 or so and it's driving me crazy. Glad to hear you're back to normal though -- gives me a glimmer of hope!

  3. TineCiel

    It was driving me crazy as well. My hair was really long and it looked fabulous but all that loss thinned it out a lot. I ended up having it cut a bit shorter. I was starting to wonder if I'd have to shave my head.

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