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Metformin İlişkili Laktik Asidoz; Bir Olgu Nedeni İle Literatürün Gözden Geçirilmesi

Year 2020, Volume: 3 Issue: 1, 49 - 53, 30.03.2020

Abstract

Metformin biguanid sınıfından, Tip 2 diyabetiklerde, özellikle böbrek fonksiyonları normal
hastalarda ilk basamakta kullanılan oral antidiyabetiktir. Metforminin en ciddi ve ölümcül yan
etkisi laktik asidozdur. Böbrek yetersizliği laktat atılım bozukluğunun en sık sebebidir. Acil
serviste, suisid amaçlı ilaç alımından sonra yüksek anyon açıklı metabolik asidoz varlığı olan
hastalarda metformin intoksikasyonu düşünülmelidir. 44 yaşında kadın hasta intihar amaçlı
50 gram metformin alımından 3 saat sonra acil servise bulantı ve karında şişkinlik şikâyeti
ile başvurdu. Hastada metformin ilişkili laktik asidoz (pH<7.35, laktat düzeyi>5 mmol/L ve
bikarbonat<22 mmol/L) tanımlandı. Erken tanı ve hemodiyaliz veya hemofiltrasyon yöntemleri
ile metabolik asidozun hızlı düzeltilmesi, destek tedavisi ve kan glikoz düzeyinin ayarlanması
pozitif sonuçlara neden olacaktır.

References

  • 1. American Diabetes Association. Standards of medical care in diabetes-2013. Diabetes Care 2013; 36(1): 11-66. 2. Lalau JD. Lactic acidosis induced by metformin: incidence, management and prevention. Drug Saf 2010; 33(9): 727-40. 3. Ahmad S, Beckett M. Recovery from ph 6.38: Lactic acidosis by hypothermia. Emerg Med J 2002; 19: 169-71. 4. Orban JC, Giunti C, Levraut J et al. L’acidose lactique reste une complication grave du traitement par metformine metformin-associated lactic acidosis remains a serious complication of metformin therapy. Ann Fr Anesth Reanim 2003; 22: 461-5. 5. Bailey CJ, Wilcock C, Day C. Effct of metformin on glucose metabolism in the splanchic bed. Br J Pharmacol 1992; 105: 1009-13. 6. Stang M, Wysowski DK, Butler-Jones D. Incidence of lactic acidosis in metformin users. Diabetes Care 1999; 22(6): 925-7. 7. Van Berlo-van de Laar IR, Vermeij CG, Doorenbos CJ. Metformin associated lactic acidosis: incidence and clinical correlation with metformin serum concentration measurements. J Clin Pharm Ther 2011; 36(3): 376-82. 8. Vecchio S, Giampreti A, Petrolini VM et al. Metformin accumulation: lactic acidosis and high plasmatic metformin levels in a retrospective case series of 66 patients on chronic therapy. Clin Toxicol (Phila) 2014; 52(2): 129-35. 9. Kajbaf F, Lalau JD. The prognostic value of blood pH and lactate and metformin concentrations in severe metformin-associated lactic acidosis. BMC Pharmacol Toxicol 2013; 14: 22. 10. Stacpoole PW, Wright EC, Baumgartner TG et al. Natural history and course of acquired lactic acidosis in adults. DCA-lactic acidosis study group. Am J Med 1994; 97: 47-5414. 11. Dell’Aglio DM, Perino LJ, Kazzi Z et al. Acute metformin overdose: examining serum pH, lactate level, and metformin concentrations in survivors versus nonsurvivors: a systematic review of the literature. Ann Emerg Med 2009; 54(6): 818-23. 12. Kajbaf F, Lalau JD. Mortality rate in so-called “metformin-associated lactic acidosis”: a review of the data since the 1960s. Pharmacoepidemiol Drug Saf 2014; 23(11): 1123-7. 13. Renda F, Mura P, Finco G et al. Metforminassociated lactic acidosis requiring hospitalization. A national 10 year survey and a systematic literature review. Eur Rev Med Pharmacol Sci 2013; 17: 45-9. 14. Lalau JD, Race JM, Brinquin L. Lactic acidosis in metformin therapy. Relationship between plasma metformin concentration and renal function. Diabetes Care. 1998; 21(8): 1366-7. 15. Heaney D, Majid A, Junor B. Bicarbonate haemodialysis as a treatment of metformin overdose. Nephrol Dial Transplant 1997; 12(5): 1046-7. 16. Barrueto F, Meggs WJ, Barchman MJ. Clearance of metformin by hemofitration in overdose. J Toxicol Clin Toxicol 2002; 40(2): 177-80. 17. Arroyo AM, Walroth TA, Mowry JB, Kao LW. The MALAdy of metformin poisoning: Is CVVH the cure? Am J Ther. 2010; 17(1): 96-00. 18. Panzer U, Kluge S, Kreymann G, Wolf G. Combination of intermittent haemodialysis and the high-volume continous haemofitration for the treatment of severe metformin-induced lactic acidosis. Nephrol Dial Transplant 2004; 19: 2157- 2158. 19. Fall PJ, Szerlip HM. Lactic acidosis: from sour milk to septic shock. J Intensive Care Med 2005; 20: 255-71. 20. Thomas AN, Guy JM, Kishen R, et al. Comparison of lactate and bicarbonate buffred haemofitration flids: use in critically ill patients. Nephrol Dial Transplant 1997; 12: 1212-7. 21. Rachoin JS, Weisberg LS, McFadden CB. Treatment of lactic acidosis: appropriate confusion. J Hosp Med 2010; 5: E1-7. 22. Di Grande A, Vancheri F, Giustolisi V et al. Metformin-induced lactic acidosis in a type 2 diabetic patient with acute renal failure. Clin Ter 2008; 159: 87-89. 23. Bruijstens LA, van Luin M, Buscher-Jungerhans PM, Bosch FH. Reality of severe metformininduced lactic acidosis in the absence of chronic renal impairment. Neth J Med. 2008; 66(5): 185-90. 24. Tay S, Lee IL. Survival after cardiopulmonary arrest with extreme hyperkalaemia and hypothermia in a patient with metformin-associated lactic acidosis. BMJ Case Rep 2012 20; 2012. pii: bcr2012007804. 25. Teale KF, Devine A, Stewart H, Harper NJ. The management of metformin overdose. Anaesthesia 1998; 53: 698-701. 26. Schelling JR, Howard RL, Winter SD, Linas SL. Increased osmolal gap in alcoholic ketoacidosis and lactic acidosis. Ann Intern Med 1990; 113: 580-582. 27. Forsythe SM, Schmidt GA. Sodium Bicarbonate for the Treatment of lactic acidosis. Chest 2000; 117: 260-7. 28. Baştürk T, Balkan B, Aytekin M et al. Lactic Acidosis due to Metformin Overdose. What treatment should be? A Case Report and Review of the Literature. BANTAO Journal 2009; 7 (2): 44- 46. 29. Rifkin SI, McFarren C, Juvvadi R, Weinstein SS. Prolonged hemodialysis for severe metformin intoxication. Ren Fail 2011; 33(4): 459-61.
Year 2020, Volume: 3 Issue: 1, 49 - 53, 30.03.2020

Abstract

References

  • 1. American Diabetes Association. Standards of medical care in diabetes-2013. Diabetes Care 2013; 36(1): 11-66. 2. Lalau JD. Lactic acidosis induced by metformin: incidence, management and prevention. Drug Saf 2010; 33(9): 727-40. 3. Ahmad S, Beckett M. Recovery from ph 6.38: Lactic acidosis by hypothermia. Emerg Med J 2002; 19: 169-71. 4. Orban JC, Giunti C, Levraut J et al. L’acidose lactique reste une complication grave du traitement par metformine metformin-associated lactic acidosis remains a serious complication of metformin therapy. Ann Fr Anesth Reanim 2003; 22: 461-5. 5. Bailey CJ, Wilcock C, Day C. Effct of metformin on glucose metabolism in the splanchic bed. Br J Pharmacol 1992; 105: 1009-13. 6. Stang M, Wysowski DK, Butler-Jones D. Incidence of lactic acidosis in metformin users. Diabetes Care 1999; 22(6): 925-7. 7. Van Berlo-van de Laar IR, Vermeij CG, Doorenbos CJ. Metformin associated lactic acidosis: incidence and clinical correlation with metformin serum concentration measurements. J Clin Pharm Ther 2011; 36(3): 376-82. 8. Vecchio S, Giampreti A, Petrolini VM et al. Metformin accumulation: lactic acidosis and high plasmatic metformin levels in a retrospective case series of 66 patients on chronic therapy. Clin Toxicol (Phila) 2014; 52(2): 129-35. 9. Kajbaf F, Lalau JD. The prognostic value of blood pH and lactate and metformin concentrations in severe metformin-associated lactic acidosis. BMC Pharmacol Toxicol 2013; 14: 22. 10. Stacpoole PW, Wright EC, Baumgartner TG et al. Natural history and course of acquired lactic acidosis in adults. DCA-lactic acidosis study group. Am J Med 1994; 97: 47-5414. 11. Dell’Aglio DM, Perino LJ, Kazzi Z et al. Acute metformin overdose: examining serum pH, lactate level, and metformin concentrations in survivors versus nonsurvivors: a systematic review of the literature. Ann Emerg Med 2009; 54(6): 818-23. 12. Kajbaf F, Lalau JD. Mortality rate in so-called “metformin-associated lactic acidosis”: a review of the data since the 1960s. Pharmacoepidemiol Drug Saf 2014; 23(11): 1123-7. 13. Renda F, Mura P, Finco G et al. Metforminassociated lactic acidosis requiring hospitalization. A national 10 year survey and a systematic literature review. Eur Rev Med Pharmacol Sci 2013; 17: 45-9. 14. Lalau JD, Race JM, Brinquin L. Lactic acidosis in metformin therapy. Relationship between plasma metformin concentration and renal function. Diabetes Care. 1998; 21(8): 1366-7. 15. Heaney D, Majid A, Junor B. Bicarbonate haemodialysis as a treatment of metformin overdose. Nephrol Dial Transplant 1997; 12(5): 1046-7. 16. Barrueto F, Meggs WJ, Barchman MJ. Clearance of metformin by hemofitration in overdose. J Toxicol Clin Toxicol 2002; 40(2): 177-80. 17. Arroyo AM, Walroth TA, Mowry JB, Kao LW. The MALAdy of metformin poisoning: Is CVVH the cure? Am J Ther. 2010; 17(1): 96-00. 18. Panzer U, Kluge S, Kreymann G, Wolf G. Combination of intermittent haemodialysis and the high-volume continous haemofitration for the treatment of severe metformin-induced lactic acidosis. Nephrol Dial Transplant 2004; 19: 2157- 2158. 19. Fall PJ, Szerlip HM. Lactic acidosis: from sour milk to septic shock. J Intensive Care Med 2005; 20: 255-71. 20. Thomas AN, Guy JM, Kishen R, et al. Comparison of lactate and bicarbonate buffred haemofitration flids: use in critically ill patients. Nephrol Dial Transplant 1997; 12: 1212-7. 21. Rachoin JS, Weisberg LS, McFadden CB. Treatment of lactic acidosis: appropriate confusion. J Hosp Med 2010; 5: E1-7. 22. Di Grande A, Vancheri F, Giustolisi V et al. Metformin-induced lactic acidosis in a type 2 diabetic patient with acute renal failure. Clin Ter 2008; 159: 87-89. 23. Bruijstens LA, van Luin M, Buscher-Jungerhans PM, Bosch FH. Reality of severe metformininduced lactic acidosis in the absence of chronic renal impairment. Neth J Med. 2008; 66(5): 185-90. 24. Tay S, Lee IL. Survival after cardiopulmonary arrest with extreme hyperkalaemia and hypothermia in a patient with metformin-associated lactic acidosis. BMJ Case Rep 2012 20; 2012. pii: bcr2012007804. 25. Teale KF, Devine A, Stewart H, Harper NJ. The management of metformin overdose. Anaesthesia 1998; 53: 698-701. 26. Schelling JR, Howard RL, Winter SD, Linas SL. Increased osmolal gap in alcoholic ketoacidosis and lactic acidosis. Ann Intern Med 1990; 113: 580-582. 27. Forsythe SM, Schmidt GA. Sodium Bicarbonate for the Treatment of lactic acidosis. Chest 2000; 117: 260-7. 28. Baştürk T, Balkan B, Aytekin M et al. Lactic Acidosis due to Metformin Overdose. What treatment should be? A Case Report and Review of the Literature. BANTAO Journal 2009; 7 (2): 44- 46. 29. Rifkin SI, McFarren C, Juvvadi R, Weinstein SS. Prolonged hemodialysis for severe metformin intoxication. Ren Fail 2011; 33(4): 459-61.
There are 1 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Case study
Authors

Bedih Balkan

Güray Demir

Fevzi Balkan

Halil Çetingök This is me

Erdal Atiç

Publication Date March 30, 2020
Acceptance Date December 16, 2019
Published in Issue Year 2020 Volume: 3 Issue: 1

Cite

APA Balkan, B., Demir, G., Balkan, F., Çetingök, H., et al. (2020). Metformin İlişkili Laktik Asidoz; Bir Olgu Nedeni İle Literatürün Gözden Geçirilmesi. Tıp Fakültesi Klinikleri Dergisi, 3(1), 49-53.


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