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Hayati Tehlike oluşturacak Düzeyde Derin Metabolik Asidoz ile Seyreden Metformin İntoksikasyonu

Year 2018, Volume: 1 Issue: 3, 35 - 39, 30.11.2018

Abstract

Metformin hem karaciğerdeki endojen glukoz üretimini baskılayarak hem yağ ve kas dokusu
gibi periferik dokularda insülinin duyarlılığını artırarak özellikle insülin direncinin ön planda
olduğu Tip 2 Diabetes Mellitusta kullanılan biguanid türevi bir antidiyabetik ilaçtır. Nadir
görülse de Metforminin en önemli yan etkisi laktik asidoz geliştirmesidir. Metabolik asidoz
bazen hayati tehdit edecek düzeyde olabilir. Tedavisinde mekanik ventilasyon desteği ve renal
replasman tedavileri gibi ileri düzey tedavilere ihtiyaç duyulabilir. Bu yazıda suisid amacı ile
yüksek doz metformin alımı sonrası yoğun bakım ünitesinde takip edilen 20 yaşındaki bir olgu
tartışılmıştır. Hasta, ilaç alımı sonrasında acil servise getirilmiştir. Derin metabolik asidoz ve
solunum sıkıntısı ile yoğun bakım ünitesine alınmıştır. Kan gazı örneklerinde pH:6.93 düzeyine
kadar gerilemiş, laktat düzeyi ise 22 mmol/L’ye kadar yükselmiştir. Hastanın destek tedavilere
ek olarak uzun süre mekanik ventilasyon desteği ve renal replasman tedavisine ihtiyacı olmuştur.
Olgu, 8 günlük yoğun bakım tedavisi sonrasında sağkalım ile taburcu edilmiştir
  

References

  • 1.Hulisz DT, Bonfiglio MF, Murray RD. Metforminassociated lactic acidosis. J Am Board Fam Pract 1998; 11: 233-236. 2.Fonseca V, Rosenstock J, Patwardhan R, et al. Effect of metformin and rosiglitazone combination therapy in patients with type 2 diabetes mellitus: A randomized controlled trial. JAMA 2000; 283: 1695-1702. 3.Gomez-Perez FJ,Fanghanel-Salmon G,et al. Efficacy and safety of rosiglitazone plus metformin in Mexicans with type 2 diabetes. Diabetes Metab Res Rev 2002; 18: 127-134. 4.Di Cicco RA, Allen A, Carr A, et al. Rosiglitazone does not after the pharmacokinetics of metformin. J Clin Pharmacol 2000; 40: 1280-1285. 5.Bolen S, Feldman L, Vassy, Wilson L, et al. Systematic review: Comparative effectivenes and safety of oral medications for type 2 diabetes mellitus. Ann Intern Med 2007 ; 147: 386-399. 6.Khurama R, Mahk IS. Metformin safety in cardiac patients. Herat 2010; 96: 99-102. 7.Maharani U. Diabetes Mellitus & Hypoglycemia (49 th ed). In: Papadakis MA, Mc Phee SJ (Eds), Current Medical Diagnosis and Treatment. Mc Graw-Hill Medical 2009: p.1092-1093. 8.Lalav JD, Race JM. Lactic acidosis in metformin treated patients. Prognostic value of arterial lactate levels and plasma metformin concentrations. Drug Saf 1999; 20: 377-384. 9.Panzer U, Kluge S, Kreymann G, Wolf G. Combination of intermittent heamodialysis and high volume continuous heamofiltrasyon for the treatment of severe metformin-induced lactic acidosis. Nephrol Dial Transplant 2004; 19: 2157- 2158. 10.Lalau JD, Mourlhon Ç, Bergeret A, Lacroix C. Consequences of metformin intoxication. Diabetes Care 1998; 21: 2036-2037. 11.Heaney D, Majial A, Junor B. Bicarbonate heamodialysis as a treatment of metformin overdose. Nephrol Dial Transplant 1997; 12: 1046- 1047. 12.Soderstorm J, Murray L, Daly FF, Little M. Toxicology case of the month: oral hypoglycemic overdose. Emerg Med J 2006; 23: 565-567. 13.Barrueto F, Meggs WS, Barchman MJ. Clearance of metformin by hemofiltration in overdose. J Toxicol Clin Toxicol 2002; 40: 177-180 14.Mallick S. Metformin induced acute pancrreatitis precipiteted by renal failure. Postgrad Med J 2004; 80: 239-240. 15.Galea M, Jelacin N, Bramham K, White I. Severe lactic asidosis and rhabdomyolsis following metformin and ramipril overdose. Br J Anaesth 2007; 98: 213-215. 16.Baró-Serra A1, Guasch-Aragay B, MartínAlemany N et al. The importance of early haemodiafiltration in the treatment of lactic acidosis associated with the administration of metformin. Nefrologia 2012; 32: 664-669. 17.Nammour FE, Fayad NF, Peikin SR. Metformininduced cholestatic hepatitis. Endocr Pract 2003; 9: 307-309. 18.Babich MM, Pike I, Shiffman ML. Metformininduced acute hepatitis. Am J Med 1998; 104: 490- 492. 19.Deutsch M, Kountouras D, Dourakis SP. Metformin hepatotoxicity. Ann Intern Med 2004; 140: W25. 20.Aksayu E, Yanturalı S, Bayram B et al. A Rare Side Effect of Metformin: Metformin-Induced Hepatotoxicity. Turk J Med Sci 2007; 37: 173-175. 21.Kacmarek RM. Indications for ventilatory support. In: Raoof S, Khan FA (Eds). Mechanical Ventilation Manuel. 1sted. Philadelphia: Versa Press, 1998: p. 3. 22.Misbin R, Green R, Stadel B et al. Lactic acidosis in patients with diabetes treated with metformin. N Engl J Med 1998; 338: 265-266.
Year 2018, Volume: 1 Issue: 3, 35 - 39, 30.11.2018

Abstract

References

  • 1.Hulisz DT, Bonfiglio MF, Murray RD. Metforminassociated lactic acidosis. J Am Board Fam Pract 1998; 11: 233-236. 2.Fonseca V, Rosenstock J, Patwardhan R, et al. Effect of metformin and rosiglitazone combination therapy in patients with type 2 diabetes mellitus: A randomized controlled trial. JAMA 2000; 283: 1695-1702. 3.Gomez-Perez FJ,Fanghanel-Salmon G,et al. Efficacy and safety of rosiglitazone plus metformin in Mexicans with type 2 diabetes. Diabetes Metab Res Rev 2002; 18: 127-134. 4.Di Cicco RA, Allen A, Carr A, et al. Rosiglitazone does not after the pharmacokinetics of metformin. J Clin Pharmacol 2000; 40: 1280-1285. 5.Bolen S, Feldman L, Vassy, Wilson L, et al. Systematic review: Comparative effectivenes and safety of oral medications for type 2 diabetes mellitus. Ann Intern Med 2007 ; 147: 386-399. 6.Khurama R, Mahk IS. Metformin safety in cardiac patients. Herat 2010; 96: 99-102. 7.Maharani U. Diabetes Mellitus & Hypoglycemia (49 th ed). In: Papadakis MA, Mc Phee SJ (Eds), Current Medical Diagnosis and Treatment. Mc Graw-Hill Medical 2009: p.1092-1093. 8.Lalav JD, Race JM. Lactic acidosis in metformin treated patients. Prognostic value of arterial lactate levels and plasma metformin concentrations. Drug Saf 1999; 20: 377-384. 9.Panzer U, Kluge S, Kreymann G, Wolf G. Combination of intermittent heamodialysis and high volume continuous heamofiltrasyon for the treatment of severe metformin-induced lactic acidosis. Nephrol Dial Transplant 2004; 19: 2157- 2158. 10.Lalau JD, Mourlhon Ç, Bergeret A, Lacroix C. Consequences of metformin intoxication. Diabetes Care 1998; 21: 2036-2037. 11.Heaney D, Majial A, Junor B. Bicarbonate heamodialysis as a treatment of metformin overdose. Nephrol Dial Transplant 1997; 12: 1046- 1047. 12.Soderstorm J, Murray L, Daly FF, Little M. Toxicology case of the month: oral hypoglycemic overdose. Emerg Med J 2006; 23: 565-567. 13.Barrueto F, Meggs WS, Barchman MJ. Clearance of metformin by hemofiltration in overdose. J Toxicol Clin Toxicol 2002; 40: 177-180 14.Mallick S. Metformin induced acute pancrreatitis precipiteted by renal failure. Postgrad Med J 2004; 80: 239-240. 15.Galea M, Jelacin N, Bramham K, White I. Severe lactic asidosis and rhabdomyolsis following metformin and ramipril overdose. Br J Anaesth 2007; 98: 213-215. 16.Baró-Serra A1, Guasch-Aragay B, MartínAlemany N et al. The importance of early haemodiafiltration in the treatment of lactic acidosis associated with the administration of metformin. Nefrologia 2012; 32: 664-669. 17.Nammour FE, Fayad NF, Peikin SR. Metformininduced cholestatic hepatitis. Endocr Pract 2003; 9: 307-309. 18.Babich MM, Pike I, Shiffman ML. Metformininduced acute hepatitis. Am J Med 1998; 104: 490- 492. 19.Deutsch M, Kountouras D, Dourakis SP. Metformin hepatotoxicity. Ann Intern Med 2004; 140: W25. 20.Aksayu E, Yanturalı S, Bayram B et al. A Rare Side Effect of Metformin: Metformin-Induced Hepatotoxicity. Turk J Med Sci 2007; 37: 173-175. 21.Kacmarek RM. Indications for ventilatory support. In: Raoof S, Khan FA (Eds). Mechanical Ventilation Manuel. 1sted. Philadelphia: Versa Press, 1998: p. 3. 22.Misbin R, Green R, Stadel B et al. Lactic acidosis in patients with diabetes treated with metformin. N Engl J Med 1998; 338: 265-266.
There are 1 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Case study
Authors

Ayşegül Kuşku This is me

Publication Date November 30, 2018
Acceptance Date September 10, 2018
Published in Issue Year 2018 Volume: 1 Issue: 3

Cite

APA Kuşku, A. (2018). Hayati Tehlike oluşturacak Düzeyde Derin Metabolik Asidoz ile Seyreden Metformin İntoksikasyonu. Tıp Fakültesi Klinikleri Dergisi, 1(3), 35-39.


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