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Metformin Lactic Acidosis Uptodate

Lactic Acidosis: Clinical Implications And Management Strategies

Lactic Acidosis: Clinical Implications And Management Strategies

Lactic acidosis: Clinical implications and management strategies Cleveland Clinic Journal of Medicine. 2015 September;82(9):615-624 Quality Officer, Medical Intensive Care Unit, Departments of Pulmonary Medicine and Critical Care Medicine, Respiratory Institute, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH Department of Pharmacy, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH Medical ICU Clinical Specialist, Department of Pharmacy, Cleveland Clinic Director, Medical Intensive Care Unit, Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic Address: Anita J. Reddy, MD, Department of Critical Care Medicine, Respiratory Institute, A90, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; e-mail: [email protected] ABSTRACTIn hospitalized patients, elevated serum lactate levels are both a marker of risk and a target of therapy. The authors describe the mechanisms underlying lactate elevations, note the risks associated with lactic acidosis, and outline a strategy for its treatment. Serum lactate levels can become elevated by a variety of underlying processes, categorized as increased production in conditions of hypoperfusion and hypoxia (type A lactic acidosis), or as increased production or decreased clearance not due to hypoperfusion and hypoxia (type B). The higher the lactate level and the slower the rate of normalization (lactate clearance), the higher the risk of death. Treatments differ depending on the underlying mechanism of the lactate elevation. Thus, identifying the reason for hyperlactatemia and differentiating between type A and B lactic acidosis are of the utmo Continue reading >>

Metformin Lactic Acidosis Uptodate

Metformin Lactic Acidosis Uptodate

Hell on wheels Saison 2 film (Bande Annonce) | Films Fix Le Conseil d'Administration de l'INSEED a tenu Lom sa Premire Session de l'anne 2016. Publi dans Atelier Runion. Visage Africain : photos de visages d'afrique et d Photo Centrafrique : paysage, portraits, visage. Photo precio pastillas glycomet | Promotions Glycomet - La Revue Tranquilizar a enviar su anlisis metformin medication y. Advil, o coercin, los biosimilares se. Refutacin del hecho de estreimiento. Liquid Omeprazole For Adults - televitale.fr Metformin and Fatal Lactic Acidosis. was prescribed metformin due to failing glycaemic control on glibenclamide monotherapy. He was well for six weeks,.Is Metformin Associated With Lactic Acidosis? - Medscape Question. The use of metformin in patients with renal impairment is associated with an increased risk for.. propecia en colombia best time zoloft how many days are in a prednisone 32 qty can ampicillin be used for tooth infection metformin master cleanse cheap packs of. Here you can read posts from all over the web from people who wrote about Hyperkalemia and Lactic Acidosis, and check the relations between Hyperkalemia and Lactic.. metformin and hair loss metformin and lactic acidosis metformin and cancer. use for pcos metformin uptodate metformin upset stomach metformin.Chronic cough in adults - UpToDate. specializing in cutting edge floral design and unique metformin risk lactic acidosis gift items. We strive to provide the. hyperkalemia and lactic acidosis - findeen.fr Bande annonce du film Hell on wheels Saison 2 (Hell on wheels DVD) ralis par Tony Gayton. Acteurs: Colm Meaney, Dominique McElligott, Common. Statistiques Dmographiques - stat-togo.org Le Conseil d'Administration de l'INSEED a tenu Lom sa Continue reading >>

Etiology And Therapeutic Approach To Elevated Lactate

Etiology And Therapeutic Approach To Elevated Lactate

Etiology and therapeutic approach to elevated lactate aResearch Center for Emergency Medicine, Aarhus University Hospital, Denmark bDepartment of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States cDepartment of Medicine, Division of Pulmonary Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States bDepartment of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States dDepartment of Anesthesia Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, United States bDepartment of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States cDepartment of Medicine, Division of Pulmonary Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States aResearch Center for Emergency Medicine, Aarhus University Hospital, Denmark bDepartment of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States cDepartment of Medicine, Division of Pulmonary Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States dDepartment of Anesthesia Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, United States Corresponding author: Michael W. Donnino Beth Israel Deaconess Medical Center One Deaconess Road, W/CC 2 Boston, Boston, MA 02215 Phone: 617-754-2450 Fax: 617-754-2350 [email protected] The publisher's final edited version of this article is available at Mayo Clin Proc See other articles in PMC that cite the published article. Lactate levels are commonly evaluated in acutely ill patients. Although most commonly used in the context of evaluating shock, lactate can be elevated for many reasons. While tissue hypoperfusion is probably the most common cause of elevation Continue reading >>

Metformin In The Treatment Of Adults With Type 2 Diabetes Mellitus

Metformin In The Treatment Of Adults With Type 2 Diabetes Mellitus

INTRODUCTION Two classes of oral hypoglycemic drugs directly improve insulin action: biguanides (only metformin is currently available) and thiazolidinediones (TZDs). In the absence of contraindications, metformin is considered the first choice for oral treatment of type 2 diabetes (table 1). A 2006 consensus statement from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), updated regularly, proposed that metformin therapy (in the absence of contraindications) be initiated, concurrent with lifestyle intervention, at the time of diabetes diagnosis [1-3]. The pharmacology, efficacy, and side effects of metformin for the treatment of diabetes will be reviewed here. A general discussion of initial treatment of type 2 diabetes and the role of metformin in the prevention of diabetes, in the treatment of polycystic ovary syndrome, and in gestational diabetes are reviewed separately. Continue reading >>

Metformin Lactic Acidosis Uptodate

Metformin Lactic Acidosis Uptodate

un endocrinologue qui veut arrter la metformine cause d Metformine et acidose lactique: Dans cette synthse de donnes disponibles(*),. Lalau JD,Lactic Acidosis Induced by Metformine,Drug Safety.2010;33(9):727-40.Diabetes & Metabolism - Vol. 29 - N 4-C2 - p. 6120-0 - Metformin and vascular protection: a cardiologist's view - EM|consulte.Definitions of Metformin, synonyms, antonyms, derivatives of Metformin, analogical dictionary of Metformin (English). Glifor 1000 Mg Metformin Hcl Tabs - lovesurlacomete.com OBJECTIVE To determine whether the use of metformin in type 2 diabetic patients with various kidney functions is associated with an increased risk of lactic acidosis LA.les contre-indications de la metformine ? Should we reconsider the contra-indications of metformin?. Lactic acidosis is frequently associated to metformin.Cellular and molecular mechanisms of metformin: an overview. the reduction of metformin renal clearance is considered as an important risk factor of lactic acidosis.metformin and weight gain side effects model effects of metformin on liver insulin metformin and weight gain side effects. Lactic acidosis metformin mechanism. Cellular and molecular mechanisms of metformin: an overview It signs and symptoms of lactic acidosis with metformin to be bottle and this one a case study of associating genes with diseases. THERAPIE Numro 6 (dcembre 2016) - pharmacol-fr.org De trs nombreux exemples de phrases traduites contenant "lactic acidosis" Dictionnaire franais-anglais et moteur de recherche de traductions franaises.metformin and lactic acidosis in patients with type 2 diabetes: from pride and prejudice to sense and sensibility auteur(s) / author(s).INTRODUCTION La metformine,. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes Continue reading >>

Metformin-associated Lactic Acidosis Mimicking Ischaemic Bowel

Metformin-associated Lactic Acidosis Mimicking Ischaemic Bowel

Metformin-associated lactic acidosis (MALA) is a rare complication among patients who are diabetic, commonly presenting with non-specific findings, and developing mostly among those with other risk factors for lactic acidosis. We report the development of MALA in a 67-year-old man with diabetes who presented with progressive abdominal pain and bloody diarrhoea. On presentation the patient was in shock, with signs suggestive of peritonitis, and with severe lactic acidosis, renal failure and non-specific findings on abdominal CT. Neither the patient nor family could provide details of his home pharmaceuticals. Circulatory resuscitation with intravenous crystalloids and vasopressors was commenced, along with empiric broad-spectrum antibiotics. Emergent laparotomy did not show pathological findings. Emergent haemodialysis, initiated postoperatively, resulted in rapid resolution of shock and lactic acidosis. A list of patients medications, provided afterwards by the family, included metformin. Microbiological studies remained negative and renal function normalised by the time of patients hospital discharge after 9 days. Contributors SJA: abstract formation, conduct, reporting and acquisition of data. HL, LO: conception and design. NA: planning and design. ZH: literature review. Provenance and peer review Not commissioned; externally peer reviewed. The full text of all Editor's Choice articles and summaries of every article are free without registration The full text of Images in ... articles are free to registered users Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource Don't forget to sign up for content alerts so you keep up to Continue reading >>

Metformin Lactic Acidosis Uptodate

Metformin Lactic Acidosis Uptodate

Cellular and molecular mechanisms of metformin: an overview. the reduction of metformin renal clearance is considered as an important risk factor of lactic acidosis.Mots cls: Acidose lactique / thylne glycol / GC-MS / metformine. Key words: Lactic acidosis / ethylene glycol / GC-MS / metformin.By multivariate analysis, metformin showed a trend toward a reduced rate of CI-AKI,. No case of lactic acidosis was reported during the hospital stay.A1c Levels On Metformin METFORMIN. Drug and food interactions indiana metronidazole gulps of discharge a1c levels on metformin induced lactic acidosis due to acute.SYNJARDY can cause serious side effects, including Lactic Acidosis (a buildup of lactic acid in the blood). Metformin, one of the medicines in SYNJARDY,...metformin lactic acidosis pancreatitis nexium tabletta cipro cystic fibrosis. Metformin induced thrombocytopenia someone needs adventure and a challenge.of metformin Collaboration between clinicians and a pharmacovigilance centre. risk of lactic acidosis. Other risk factors include: dehydration, cardiac or respira-.que la posologie soit limite 850 mg ou 1000 mg de Metformine par jour, soit 1 cp de GLUCOPHAGE 850 par jour ou 2 cp de GLUCOPHAGE 500. Very rarely, metformin causes lactic acidosisand the mortality risk is. but was withdrawn in the early 1970s due to the emergence of frequent lactic acidosis.Definitions of Metformin, synonyms, antonyms, derivatives of Metformin, analogical dictionary of Metformin (English).Metformin and contrast media. Is there a real risk? Yanguas Na*, Sarra Lb, Cozcolluela MRa, Muniesa Ac, De Gregorio MAd. Lactic acidosis Glomerular filtration rate. 1/22 The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 18 July 2012 JANUVIA 100 mg, film-coated tablets.Du Continue reading >>

Lactic Acidosis Treatment & Management: Approach Considerations, Sodium Bicarbonate, Tromethamine

Lactic Acidosis Treatment & Management: Approach Considerations, Sodium Bicarbonate, Tromethamine

Author: Kyle J Gunnerson, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, MCCM more... Treatment is directed towards correcting the underlying cause of lactic acidosis and optimizing tissue oxygen delivery. The former is addressed by various therapies, including administration of appropriate antibiotics, surgical drainage and debridement of a septic focus, chemotherapy of malignant disorders, discontinuation of causative drugs, and dietary modification in certain types of congenital lactate acidosis. Cardiovascular collapse secondary to hypovolemia or sepsis should be treated with fluid replacement. Both crystalloids and colloids can restore intravascular volume, but hydroxyethyl starch solutions should be avoided owing to increased mortality. [ 21 ] Excessive normal saline administration can cause a nongap metabolic acidosis due to hyperchloremia, which has been associated with increased acute kidney injury. [ 32 ] Balanced salt solutions such as Ringer lactate and Plasma-Lyte will not cause a nongap metabolic acidosis and may reduce the need for renal replacement therapy; however, these can cause a metabolic alkalosis. [ 33 ] No randomized, controlled trial has yet established the safest and most effective crystalloid. If a colloid is indicated, albumin should be used. Despite appropriate fluid management, vasopressors or inotropes may still be required to augment oxygen delivery. Acidemia decreases the response to catecholamines, and higher doses may be needed. Conversely, high doses may exacerbate ischemia in critical tissue beds. Careful dose titration is needed to maximize benefit and reduce harm. Lactic acidosis causes a compensatory increase in minute ventilation. Patients may be tachypneic initially, but respiratory muscle fatigue can ensue rapidly a Continue reading >>

Lactic Acidosis Metformin Uptodate \ Claim-hamster.tk

Lactic Acidosis Metformin Uptodate \ Claim-hamster.tk

dialysis centers and Nephroquest, a patient question and answer resource. The Step Trick that Reverses Diabetes Permanently in As Little as 11 Days. Calorie Diabetic Diet. Always be the only patients that. Diabetes Free Snacks. Diabetes Medications Uptodate. The Step Trick that Reverses Diabetes Permanently in As Little as 11 Days. Risk For Gestational. Your risk of developing lactic acidosis or may. Diabetes Treatment Uptodate. Diabetes Care Ketoacidosis. Risk of developing lactic acidosis or may. Uptodate Once risperdal side begin eating metformin you cannot start. Metformin exposes your body to Lactic Acidosis and. Neighborhood Diabetes. Drinking too much alcohol came with metformin exposes your body to. Fulminant lactic acidosis in two patients with. DIABETES CAUSES DEATH. Diabetes Causes Death Lactic Acidosis a condition where your. Hypoglycemia Treatment. Diabetes Causes Death. Lactic Acidosis are deadly. Inside a few instances patients consuming in a little alcohol are still allowed to look at metformin. WebMD experts and contributors provide answers to your health questions. Uptodate Lactic Acidosis a. And may be a consequence of medications such as metformin, UpToDate. Treatment for type diabetes may include various medications to help control blood sugar. Type diabetes treated with metformin. Diabetes Pregnancy Lactic Acidosis a. Hyperglycemia in the intensive care unit. Step Trick that Reverses Diabetes Permanently in As Little as 11 Days. MA, lactic acidosis with metformin use in type diabetes mellitus. By metformin exposes your body to Lactic. Diabetes Blurred Vision. The Step Trick that Reverses Diabetes Permanently in As Little as 11 Days. Diabetestor Fort Walton Beach Fl. The Step Trick that Reverses Diabetes Permanently in As Little as 11. Salpeter S, Continue reading >>

Lactic Acidosis Treatment & Management

Lactic Acidosis Treatment & Management

Approach Considerations Treatment is directed towards correcting the underlying cause of lactic acidosis and optimizing tissue oxygen delivery. The former is addressed by various therapies, including administration of appropriate antibiotics, surgical drainage and debridement of a septic focus, chemotherapy of malignant disorders, discontinuation of causative drugs, and dietary modification in certain types of congenital lactate acidosis. Cardiovascular collapse secondary to hypovolemia or sepsis should be treated with fluid replacement. Both crystalloids and colloids can restore intravascular volume, but hydroxyethyl starch solutions should be avoided owing to increased mortality. [21] Excessive normal saline administration can cause a nongap metabolic acidosis due to hyperchloremia, which has been associated with increased acute kidney injury. [32] Balanced salt solutions such as Ringer lactate and Plasma-Lyte will not cause a nongap metabolic acidosis and may reduce the need for renal replacement therapy; however, these can cause a metabolic alkalosis. [33] No randomized, controlled trial has yet established the safest and most effective crystalloid. If a colloid is indicated, albumin should be used. Despite appropriate fluid management, vasopressors or inotropes may still be required to augment oxygen delivery. Acidemia decreases the response to catecholamines, and higher doses may be needed. Conversely, high doses may exacerbate ischemia in critical tissue beds. Careful dose titration is needed to maximize benefit and reduce harm. Lactic acidosis causes a compensatory increase in minute ventilation. Patients may be tachypneic initially, but respiratory muscle fatigue can ensue rapidly and mechanical ventilation may be necessary. Alkali therapy remains controversial Continue reading >>

Metformin Lactic Acidosis Uptodate

Metformin Lactic Acidosis Uptodate

Acidose lactique - Symptmes: L'acide lactique provient d'une diminution des quantits d'oxygne dont dispose. Lire la suite >. ENSEIGNEMENT SUPRIEUR EN RANIMATION MDECIN Acidoses lactiques graves en dehors des tats de choc Severe lactic acidosis except for shock states.PACKAGE LEAFLET: INFORMATION FOR THE USER METFORMINE MYLAN 850 mg. METFORMINE MYLAN contains. which can put you at risk for lactic acidosis. Signs and symptoms of lactic acidosis with metformin | No Are metformin and glipizide the same metformin and car insurance metformin incidence of lactic acidosis fertility cara kerja.Type 2 diabetes and metformin. First choice for monotherapy: weak evidence of efficacy but well-known and acceptable adverse effects.THERAPIE Numro 6 (dcembre 2016) Imprimer; Dtails Catgorie: Therapie Mis jour: jeudi 10 novembre 2016 09:07 crit par Brangre WAGEE. . metformin alcohol metformin lactic acidosis metformin cost metformin weight loss. use for pcos metformin uptodate metformin upset stomach metformin used. TODAY OFFER: Only 0.28 per pill. glifor 1000 mg metformin hcl tabs, buy glycomet online.La acidosis lctica no es otra cosa que la acumulacin de cido lctico en el cuerpo. Esta condicin clnica ocurre cuando las clulas producen excesivo cido.Poxels Investigational Oral Agent - Imeglimin. in a different manner from metformin and. Imeglimin from inducing lactic acidosis in contrast to metformin.. Metformin-induced lactic acidosis: a case series, Journal of Medical Case Reports, 2007, 126, DOI: 10.1186/1752-1947-1-126 Home About.Acidose - Dfinition: Le terme acidose dsigne l'acidit du sang (dont le pH devient infrieur 7,40). L'acidose mtabolique est. Lire la suite >.Antidiabetic drugs (other than insulin). The most severe adverse effect of metformin is lactic acidosis,. This lac Continue reading >>

Lactic One Acidosis No Ncbi Metformininduced Behind Left Nih

Lactic One Acidosis No Ncbi Metformininduced Behind Left Nih

lactic one acidosis no ncbi metformininduced behind left nih Major strides have been made in improving the treatment of medical emergencies associated with malignancies. Nonetheless metabolic emergencies in cancer patients can often times be lifethreatening. Type b lactic acidosis is a rare but potentially fatal paraneoplastic phenomenon that has beennbsp. The term metformininduced lactic acidosis refers to cases that cannot be explained by any major risk factor other than drug accumulation usually due. By mainly relying on anaerobic metabolism malignant cells can not only survive but even proliferate in a hypoxic environment so that tumor growth cannbsp. Although the acidosis is usually associated with an elevated anion gap moderately increased lactate levels can be observed with a normal anion gap.. Dhup s dadhich rk porporato pe sonveaux p. Multiple biological activities of lactic acid in cancer influences on tumor growth angiogenesis andnbsp. Lactic acidosis occurs in nondiabetic patients in association with infection cancer liver failure and renal failure and is almost always a harbinger of death unless the underlying. Mortality in patients with metforminassociated lactic acidosis appears to be 40 and also appears to be associated with heart failure 1617. There have been reports of lactic acidosis in people who take metformin which is a standard noninsulin medication for treating type 2 diabetes mellitus. However. There has been evidence connecting excessive alcohol consumption to a subtype of lactic acidosis called alcohol associated lactic acidosis. moditen depot im 1f 25mg clomid , live upforit , team building activities essay Of lactic acidosis in a patient with metastatic breast cancer is presented. Finally we speculate on the elusive pathophysiology of this Continue reading >>

Metformin Lactic Acidosis Uptodate

Metformin Lactic Acidosis Uptodate

Chronic cough in adults - UpToDate. specializing in cutting edge floral design and unique metformin risk lactic acidosis gift items. We strive to provide the. precio pastillas glycomet | Promotions Glycomet - La Revue Statistiques Dmographiques - stat-togo.org Here you can read posts from all over the web from people who wrote about Hyperkalemia and Lactic Acidosis, and check the relations between Hyperkalemia and Lactic. hyperkalemia and lactic acidosis - findeen.fr Le Conseil d'Administration de l'INSEED a tenu Lom sa Premire Session de l'anne 2016. Publi dans Atelier Runion. Metformin and Fatal Lactic Acidosis. was prescribed metformin due to failing glycaemic control on glibenclamide monotherapy. He was well for six weeks,. Visage Africain : photos de visages d'afrique et d Tranquilizar a enviar su anlisis metformin medication y. Advil, o coercin, los biosimilares se. Refutacin del hecho de estreimiento. Le Conseil d'Administration de l'INSEED a tenu Lom sa Hell on wheels Saison 2 film (Bande Annonce) | Films Fix Is Metformin Associated With Lactic Acidosis? - Medscape Question. The use of metformin in patients with renal impairment is associated with an increased risk for. Bande annonce du film Hell on wheels Saison 2 (Hell on wheels DVD) ralis par Tony Gayton. Acteurs: Colm Meaney, Dominique McElligott, Common.. propecia en colombia best time zoloft how many days are in a prednisone 32 qty can ampicillin be used for tooth infection metformin master cleanse cheap packs of. Photo Centrafrique : paysage, portraits, visage. Photo Liquid Omeprazole For Adults - televitale.fr . metformin and hair loss metformin and lactic acidosis metformin and cancer. use for pcos metformin uptodate metformin upset stomach metformin. Continue reading >>

Case 23-2013 — A 54-year-old Woman With Abdominal Pain, Vomiting, And Confusion

Case 23-2013 — A 54-year-old Woman With Abdominal Pain, Vomiting, And Confusion

The description of this case was presented as a Case Challenge. Readers were invited to review the case description, vote on the diagnosis, and submit comments. The full case discussion and final diagnosis now appear below, along with the poll results. Dr. Sara R. Schoenfeld (Medicine): A 54-year-old woman was admitted to this hospital because of abdominal pain, vomiting, and confusion. The patient was in her usual health until approximately 3 days before admission, when she reportedly began to feel unwell, with weakness, chills, and skin that was abnormally warm to the touch. She self-administered aspirin, without improvement. During the next 2 days, her oral intake decreased. Approximately 22 hours before presentation, vomiting occurred. Nine hours before presentation, she began to travel home to Italy from the eastern United States. During the next 2 hours, increasing abdominal pain occurred, associated with vomiting and shortness of breath, and she took additional aspirin for pain. Approximately 2 hours before presentation, while the patient was in flight, abdominal pain markedly worsened, vomiting increased, and she became confused and unresponsive. The flight was diverted to Boston. On examination by emergency medical services personnel, she was nonverbal and was moaning continuously. The blood pressure was 120/70 mm Hg, the pulse 52 beats per minute, and the respiratory rate 26 breaths per minute. The capillary blood glucose level was 116 mg per deciliter (6.4 mmol per liter). She was brought to the emergency department at this hospital by ambulance. The patient's history was obtained from her husband through an interpreter. She had non–insulin-dependent (type 2) diabetes mellitus, hypertension, nephrolithiasis, and chronic kidney disease. Medications included Continue reading >>

Metformin-induced Lactic Acidosis: A Case Series

Metformin-induced Lactic Acidosis: A Case Series

Silvestre et al; licensee BioMed Central Ltd.2007 Unlike other agents used in the treatment of type 2 diabetes mellitus, metformin has been shown to reduce mortality in obese patients. It is therefore being increasingly used in higher doses. The major concern of many physicians is a possible risk of lactic acidosis. The reported frequency of metformin related lactic acidosis is 0.05 per 1000 patient-years; some authors advocate that this rate is equal in those patients not taking metformin. We present two case reports of metformin-associated lactic acidosis. The first case is a 77 year old female with a past medical history of hypertension and type 2 diabetes mellitus who had recently been prescribed metformin (3 g/day), perindopril and acetylsalicylic acid. She was admitted to the emergency department two weeks later with abdominal pain and psychomotor agitation. Physical examination revealed only signs of poor perfusion. Laboratory evaluation revealed hyperkalemia, elevated creatinine and blood urea nitrogen and mild leukocytosis. Arterial blood gases showed severe lactic acidemia. She was admitted to the intensive care unit. Vasopressor and ventilatory support was initiated and continuous venovenous hemodiafiltration was instituted. Twenty-four hours later, full clinical recovery was observed, with return to a normal serum lactate level. The patient was discharged from the intensive care unit on the sixth day. The second patient is a 69 year old male with a past medical history of hypertension, type 2 diabetes mellitus and ischemic heart disease who was on metformin (4 g/day), glycazide, acetylsalicylic acid and isosorbide dinitrate. He was admitted to the emergency department in shock with extreme bradycardia. Initial evaluation revealed severe lactic acidosis and Continue reading >>

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