Metformin Raised Lactate

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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-associated Lactic Acidosis

OVERVIEW metformin use is associated with lactic acidosis, but it remians controversial as a disease entity MECHANISM the mechanism of lactic acidosis is uncertain Metabolic effects of metformin include: decreased gluconeogenesis increased peripheral glucose uptake decreased fatty acid oxidation CLINICAL FEATURES presence of risk factors abdominal pain nausea and vomiting fatigue myalgias altered mental status myocardial insufficiency multi-organ failure RISK FACTORS advanced age high dose renal failure (metformin is excreted unchanged in the urine) hypoxia active alcohol intake sepsis dehydration shock acidosis INVESTIGATIONS high anion gap metabolic acidosis (HAGMA) high lactate MANAGEMENT rule out other causes of lactic acidosis (sepsis, cardiogenic shock, hypoperfusion, ischaemic bowel) withdrawal of metformin RRT RRT remove metformin and correct acidosis best performed early due to large volume of distribution of metformin use hemodialysis use HCO3 buffer CONTROVERSY Some argue that metformin itself does not cause lactic acidosis, that it is actually due to the underlying conditions such as renal failure and diabetes mellitus. However, there are definite cases of lactic acidos Continue reading >>

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  1. wild_wild_wes

    Keto strip test results

    I started Keto on Monday. Today I bought the Keto test strip kit a WalMart and just tried one. The color result put me somewhere in the SMALL (15) to MODERATE (40) range, but much closer to MODERATE.
    Is that okay?

  2. lbendall

    throw them away

  3. PullAndBear

    Originally Posted by lbendall
    throw them away


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Metformin 500 mg review is here! If you want to know about Metformin how it works and Metformin side effects and also lots of other answers of questions related to metformin is given in this video.

Diabetes And Metformin Faqs

Tweet Although one of the most common drugs for type 2 diabetics, Metformin can still confuse diabetic patients. This set of FAQs are intended for information purposes, and should not replace or supersede the advice of a doctor or qualified medical professional. If you have a question about diabetes and Metformin that is not covered here, please ask the community in the Diabetes forum. Should all type 2 diabetics take Meformin? One side effect of taking Metformin is lactic acidosis, and for this reason some diabetics should not take Metformin unless specifically advised to do so by their GP or diabetes healthcare team. For this reason, diabetics with kidney problems, liver problems, and heart problems are often advised to avoid Metformin. Similarly, diabetics that are dehydrated, drink alcohol a lot, or are going to have an x-ray or surgery. For some pregnant diabetics, Metformin may not be the best choice, but in all instances this should be discussed with your doctor. Can young diabetics take Metformin? Metformin has been proven in clinical trials to lower glucose levels amongst children between 10-16 years of age suffering from type 2 diabetes. Research is less conclusive about Continue reading >>

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  1. waklee1

    I was wondering where everyone finds there ketosis sticks. I am on day 12 of induction and only lost 7lbs so far. I lost this in the first 6 days though. I haven't been using the ketosis sticks, and am thinking that I should start. Where can I find them?

  2. saffron28

    You can get the Keto stix at wal-mart. I found mine by the diabetic testing supplies. I use them about once a day, and so far have only tested in ketosis once. A lot of people swear by them and just as many say they are junk. I am not too impressed with them but that is me. I guess they are one of those YMMV things.

  3. jennabrams

    I use the Ketostix brand that you buy at a pharmacy and I test once a day. The only thing I don't like is that you actually have to go to the pharmacist and ask for them because they are behind the counter. I have tried a few brands of these including atkins, but I believe these are the most accurate. They are about $10.00 for 50 or $17 for 100 depending on where you live. I find them at Walgreens, Eckerd, Duane Reade, CVS, and Rite Aid.
    Good Luck--

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Measuring a serum lactate is crucial in the early recognition and ongoing management of a patient with suspected sepsis. This video defines normal and abnormal lactate levels and provides an overview of the management of a raised serum lactate in patients with sepsis- one of the leading causes of death in hospitals worldwide.

Extreme Lactic Acidosis Type B Associated With Metformin Treatment

Extreme lactic acidosis type B associated with metformin treatment Department of Anaesthesiology, Skne University Hospital, Lund University, Malm, Sweden Search for other works by this author on: Department of Intensive Care Medicine, Skne University Hospital, Lund University, Malm, Sweden Search for other works by this author on: Department of Endocrinology, Skne University Hospital, Lund University, Malm, Sweden Search for other works by this author on: Department of Nephrology and Transplantation, Clinical Sciences, Skne University Hospital, Lund University, Malm, Sweden Search for other works by this author on: NDT Plus, Volume 4, Issue 6, 1 December 2011, Pages 399401, Andreas Pikwer, Einar Vernersson, Anders Frid, Gunnar Sterner; Extreme lactic acidosis type B associated with metformin treatment, NDT Plus, Volume 4, Issue 6, 1 December 2011, Pages 399401, The elimination of metformin is exclusively through the kidneys and elevated plasma concentrations can cause lactic acidosis. We report a case of severe lactic acidosis (pH 6.60) occuring with ostensibly normal therapeutic doses of metformin in the setting of acute renal failure. Continuous veno-venous haemodiafiltration de Continue reading >>

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  1. Hipp

    In response to the thread for hypokalemia. I noticed diabetic ketoacidosis is mentioned as one of the causes of hypokalmia in that thread.
    Ketoacidosis is more associated with hyperkalemia not hypokalemia. In management of ketoacidosis giving insulin cause hypokalemia by shifting potassium inside the cells.

  2. tommyk

    According to all sources that I am familiar with, in Diabetic Ketoacidosis, replenishing K+ is a key factor. I think you are referring to the "falsely elevated potassium" that can initially result with DKA. With the acidosis and dehydration, patients become potassium depleted. The committment acidosis will contribute to "shifting" potassium out of the cell giving you a falsely elevated potassium. The danger is if a patient is severly potassium depleted in the face of an acidosis, with the fluids correcting the acidosis, the insulin is going to shove more potassium into the cells thus acutely lowering the serum potassium level to potentially dangerous levels. If the potassium gets lower than 2.0-2.5 one is prone to provoking lethal arrhythmias.

  3. tommyk

    TOTAL BODY Potassium deficits are high in DKA even with paradoxically high K+ due to acidotic state, which shifts H+ into cells and K+ out of cells into blood. To reiterate, the K+ is PARADOXICALLY high, not truly high. Due to the dehydration, they WILL need potassium during the treatment. This can be a great trick the boards can pull on you to make you pick the wrong answer.
    However, you bring up a great point about the inital paradoxical effect. Still, Diabetic Ketoacidosis DOES cause hypokalemia. Patients with DKA have marked fluid and electrolyte deficits. They commonly have a fluid deficit of nearly 100ml/kg, and need several hundred millimoles of potassium ion (3-5+mmol/kg) and sodium (2-10mmol/kg), as well as being deficient in phosphage (1+ mmol/kg), and magnesium. Replacement of these deficits is made more difficult due to a variety of factors, including the pH derangement that goes with DKA. Mainly in children, an added concern is the uncommon occurrence of cerebral oedema, thought by some to be related to hypotonic fluid replacement.
    Hipp, there are several mechanisms for fluid depletion in DKA. These include osmotic diuresis due to hyperglycemia, the vomiting commonly associated with DKA, and, eventually, inability to take in fluid due to a diminished level of consciousness. Electrolyte depletion is in part related to the osmotic diuresis. Potassium loss is also due to the acidotic state, and the fact that, despite total body potassium depletion, serum potassium levels are often high, predisposing to renal losses. Does this all make sense?
    Thanks for listening,

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