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Metformin Poisoning Management

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Metformin-related Lactic Acidosis: Case Report - Sciencedirect

Open Access funded by Sociedad Colombiana de Anestesiologa y Reanimacin Lactic acidosis is defined as the presence of pH <7.35, blood lactate >2.0mmol/L and PaCO2 <42mmHg. However, the definition of severe lactic acidosis is controversial. The primary cause of severe lactic acidosis is shock. Although rare, metformin-related lactic acidosis is associated with a mortality as high as 50%. The treatment for metabolic acidosis, including lactic acidosis, may be specific or general, using sodium bicarbonate, trihydroxyaminomethane, carbicarb or continuous haemodiafiltration. The successful treatment of lactic acidosis depends on the control of the aetiological source. Intermittent or continuous renal replacement therapy is perfectly justified, shock being the argument for deciding which modality to use. We report a case of a male patient presenting with metformin poisoning as a result of attempted suicide, who developed lactic acidosis and multiple organ failure. The critical success factor was treatment with continuous haemodiafiltration. Definimos acidosis lctica en presencia de pH <7.35, lactato en sangre >2.0mmol/L y PaCO2 <42mmHg. Por otro lado, la definicin de acidosis lctica gra Continue reading >>

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  1. jlr820, BSN

    Yes it is. The bloodstream is absolutely full of glucose (since it isn't entering cells and being metabolized). This glucose load makes the blood HYPERosmolar and the kidneys respond by trying to remove glucose through urination. They cannot effectively deal with the large glucose load, and that's why glucose "spills" into the urine. The process of excessive urine output secondary to the large glucose load is called osmotic diuresis, and the client loses a HUGE amount of fluid through this diuretic effect, leading to profound dehydration.

  2. NRSKarenRN

    check out these prior posts:
    question about dka - nursing for nurses
    nursing interventions - nursing for nurses
    clincal articles:
    diabetic ketoacidosis: emedicine pediatrics: cardiac disease and
    diabetic ketoacidosis: emedicine endocrinology
    how do i care for a patient with diabetic ketoacidosis
    dka nursing care plan
    acccn's critical care nursing - google books result

  3. ghurricane

    Thanks so much!! Here is another oddity that makes no sense. I know there is potassium depletion due to frequent urination, but why do labs usually indicate hyperkalemia?

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What Is Renal Failure: In this video, We will share information about what is renal failure - how to identify renal failure - symptoms of renal failure. Subscribe to our channel for more videos. Watch: (https://www.youtube.com/watch?v=ivQE7...) How to Identify Renal Failure Renal failure, also known as kidney failure, is a condition that can take two different forms: acute, when it presents itself very suddenly, and chronic, when it develops slowly over at least three months. Acute kidney failure has the potential to lead to chronic renal failure. During both types of renal failure your kidneys arent able to perform the necessary functions your body needs to stay healthy. Despite this similarity between types, the causes, symptoms, and treatments for the two kinds of renal failure vary significantly. Learning about the symptoms and causes of this disease and being able to differentiate between the two forms can be beneficial if you or a loved one have been diagnosed with renal failure. Thanks for watching what is renal failure - how to identify renal failure - symptoms of renal failure video and don't forget to like, comment and share. Related Searches: acute renal failure dr najeeb, acute renal failure explained clearly, acute renal failure kaplan, acute renal failure khan academy, acute renal failure lecture, acute renal failure management, acute renal failure medcram, acute renal failure nursing, acute renal failure treatment, acute renal failure usmle, chronic renal failure explained clearly, chronic renal failure khan academy, chronic renal failure lecture, chronic renal failure nursing, chronic renal failure treatment, chronic renal failure usmle, end stage renal failure, michael linares renal failure, pathophysiology of renal failure, renal failure, renal failure and abgs, renal failure and bone health, renal failure and dialysis, renal failure and electrolyte imbalances, renal failure and hyperkalemia, renal failure and hypocalcemia, renal failure and massage, renal failure and phosphorus, renal failure anemia, renal failure animation, renal failure bolin, renal failure calcium, renal failure care plan, renal failure case study presentation, renal failure cat, renal failure catheter, renal failure causes, renal failure causes hyperkalemia, renal failure chronic, renal failure concept map, renal failure cure, renal failure definition, renal failure diagnosis, renal failure diet, renal failure diet for humans, renal failure diet therapy, renal failure disease, renal failure dog, renal failure dr najeeb, renal failure due to ace inhibitor, renal failure electrolyte imbalance, renal failure examination, renal failure explained, renal failure fluid retention, renal failure for dummies, renal failure for nursing students, renal failure from ace inhibitor, renal failure funny, renal failure grinding, renal failure home remedy, renal failure homeopathic treatment, renal failure humans, renal failure hyperkalemia pathophysiology, renal failure icd 10, renal failure in cats, renal failure in children, renal failure in dogs, renal failure in hindi, renal failure in malayalam, renal failure in neonates, renal failure in sepsis, renal failure in the emergency department, renal failure in urdu, renal failure khan, renal failure khan academy, renal failure lab values, renal failure lecture, renal failure loss of appetite, renal failure made easy, renal failure malayalam, renal failure management, renal failure meaning in urdu, renal failure medcram, renal failure medications, renal failure metabolic acidosis, renal failure natural remedies, renal failure natural treatment, renal failure nclex, renal failure nclex questions, renal failure nucleus, renal failure nursing, renal failure nursing care plan, renal failure on dialysis, renal failure osce station, renal failure osmosis, renal failure pathology, renal failure pathophysiology, renal failure pathophysiology animation, renal failure patient, renal failure pbds, renal failure pharmacology, renal failure phases, renal failure physiology, renal failure prerenal intrarenal postrenal, renal failure pronunciation, renal failure quiz, renal failure registered nurse rn, renal failure shaking, renal failure skin itching, renal failure stage 3, renal failure stages, renal failure stories, renal failure support groups, renal failure swollen feet, renal failure symptoms, renal failure symptoms in cats, renal failure transplant, renal failure treatment, renal failure treatment in ayurveda, renal failure treatment in homeopathy, renal failure ultrasound, renal failure urine, renal failure usmle, renal failure vascular calcification, renal failure video, renal failure volume overload, renal failure vs ckd, renal failure youtube, renal kidney failure, stages of renal failure, symptoms of renal failure, types of renal failure, what is renal failure

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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  1. coreycorndog

    I posted to r/askscience for the hell of it but really this answer is all I needed.

  2. tinkan

    I think it's a pretty straight-forward yes. There is no other energy source other than stored fat and metabolic processes are conserved amongst all animals. The bear must rely on metabolizing the fat stores and that will involve ketosis (the brain likes ketones, it doesn't/can't use FFA - this is why people say the brain prefers glucose but it's really a misnomer. There are no lipid stores in the brain and free fatty acids are not soluble enough in the blood nor are they going to be able to cross the blood brain barrier. This physical barrier means brain cells can not rely on FFA for energy. Thus, FFA are converted in a more blood soluble fat energy molecule, the ketone. In short, the brain does not "require" glucose to function. It just needs time to adapt to ketone usage.)
    Just be forewarned AskScience harbors some anti-keto sentiments that we know to be false (such as loving to bring up the ketoacidosis reason or kidney troubles). But they would probably give you a better answer than us.

  3. Sporkfortuna

    IIRC, Bear recycles his urine during the long winter months.
    "Stuck in a cave, better..."

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Stroke, Diabetes, Intoxication! Are the symptoms the same? The purpose of this presentation is to provide law enforcement with a tool to identify the similarities between the signs and symptoms of Stroke, Diabetes and Intoxication.

Ph 6.68surviving Severe Metformin Intoxication

Metformin, a widely used anti-diabetic agent of the biguanide family, although generally safe, 1 , 2 , 3 , 4 holds the risk of developing a potentially lethal acidosis. 5 , 6 The association between lactic acidosis and metformin is well-established but rarely seen in patients taking this medication. 7 Its elimination relies solely on kidneys excretion, 8 so its accumulation is feasible in just two circumstances: renal failure (RF) and acute overdosage. At normal dosage, a toxic accumulation of drug requires time after the development of RF, due to metformin high clearance. About 90% of the drug is eliminated by glomerular filtration and tubular secretion (serum half-life of 1.55 h). Moreover, RF is itself associated with acidosis as it impairs kidneys ability to excrete protons. Acute intoxication on the other hand is a viable option in those cases where renal function is normal and can correlate with a psychiatric disorder. The mechanism thought to be responsible for lactic acidosis is suppression of gluconeogenesis forming lactate, pyruvate, glycerol and amino acids leading to lactate accumulation, 9 a risk that is increased by either chronic or acute RF (ARF). Usually hyperlact Continue reading >>

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Popular Questions

  1. SwimToTheMoon

    Cheat day on keto?

    Hello,
    I searched for this and found many answers on these forums and found quite a few range of answers.
    If I had one cheat day a weak where I would eat stuff like pasta or junk food would that be ok for my keto diet? Basically no counting calories, carbs or anything.
    I heard that it's not a cheat day but a "carb up", but my goal is to lose body fat, so is it still ok?
    completeidiotonnutrition/10

  2. DMurph51

    Originally Posted by SwimToTheMoon
    Hello,
    I searched for this and found many answers on these forums and found quite a few range of answers.
    If I had one cheat day a weak where I would eat stuff like pasta or junk food would that be ok for my keto diet? Basically no counting calories, carbs or anything.
    I heard that it's not a cheat day but a "carb up", but my goal is to lose body fat, so is it still ok?
    completeidiotonnutrition/10

    dont confuse a carb-load period with a cheat day. they are two very different things.
    the carb-load refills muscle gylcogen and always follows a depletion workout, thus serving a purpose within the diet. a cheat day does nothing but satisfy your cravings for your favorite foods, while typically setting you back in terms of you weight loss goals.
    if you're fortunate like i am, you can incorporate "cheat meal" foods into your carb-load period. while i've never had a cheat day ever when dieting (cutting), all of the foods that i would binge on, short of pizza and peanutbutter, i can consume en-mass during the carb-load period. im a sucker for heaping stacks of pancakes, comically large bowls of cereal, and lots of pasta. thankfully, these are all sources of carbs, consisting primarily of carbs, and are beneficial during the carb-load.
    learn to love your carbs, and essentially, your carb-load period every week will become, as you think of it a "cheat day"

  3. SwimToTheMoon

    Originally Posted by DMurph51
    dont confuse a carb-load period with a cheat day. they are two very different things.
    the carb-load refills muscle gylcogen and always follows a depletion workout, thus serving a purpose within the diet. a cheat day does nothing but satisfy your cravings for your favorite foods, while typically setting you back in terms of you weight loss goals.
    if you're fortunate like i am, you can incorporate "cheat meal" foods into your carb-load period. while i've never had a cheat day ever when dieting (cutting), all of the foods that i would binge on, short of pizza and peanutbutter, i can consume en-mass during the carb-load period. im a sucker for heaping stacks of pancakes, comically large bowls of cereal, and lots of pasta. thankfully, these are all sources of carbs, consisting primarily of carbs, and are beneficial during the carb-load.
    learn to love your carbs, and essentially, your carb-load period every week will become, as you think of it a "cheat day"

    So can I have one carb load day a week where I eat low fat, high carb foods and then just continue with low carbs for the rest of the week? I'll be knocked out of ketosis though right?

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