Efficacy of Continuous Renal Replacement Therapy in Metformin Intoxication: Case Report

Öz

Metformin-associated lactic acidosis is seen in conditions that disrupt haemodynamics such as renal failure, hepatic failure, sepsis, septic shock or in acute poisoning. Since the mortality rate of metformin-associated lactic acidosis is high, early diagnosis and treatment is important in reducing mortality. Continuous renal replacement therapy is preferred especially in clinical conditions such as severe metabolic acidosis with haemodynamic instability, intoxication, hyperkalaemia and volume overload. In our patient with lactic acidosis due to metformin intoxication, we aimed to emphasise the efficacy of continuous renal replacement therapy because of the lack of response despite two intermittent haemodialysis and haemodynamic instability.

Anahtar Kelimeler

• Continuous renal replacement therapy
• Critical care
• Metformin
• Poisoning

Metformin Zehirlenmesinde Sürekli Renal Replasman Tedavinin Etkinliği: Olgu Sunumu

Öz

Metformin ilişkili laktik asidoz böbrek yetmezliği, karaciğer yetmezliği, sepsis, septik şok gibi hemodinamiyi bozan durumlarda ya da akut zehirlenmelerde görülür. Metformin ilişkili laktik asidozun mortalitesi yüksek olduğu için erken tanı ve tedavi mortaliteyi azaltmakta önemlidir. Sürekli renal replasman tedavisi özellikle hemodinamik anstabilite ile seyreden ciddi metabolik asidoz, zehirlenme, hiperkalemi, aşırı volüm yükü gibi klinik durumlarda tercih edilmektedir. Metformin zehirlenmesine bağlı gelişen laktik asidozlu olgumuzda iki kez aralıklı hemodiyaliz uygulanmasına rağmen yanıt alınamaması ve hemodinamik anstabilitesi olması nedeniyle hastaya uygulanan sürekli renal replasman tedavisinin etkinliğini vurgulamayı amaçladık.

Anahtar Kelimeler

• Metformin
• Sürekli renal replasman tedavisi
• Yoğun bakım
• Zehirlenme

Kaynakça

1. GRADE Study Research Group, Nathan DM, Lachin JM, et al. Glycemia Reduction in Type 2 Diabetes - Glycemic Outcomes. N Engl J Med 2022; 387:1063-1074.
2. Dunn CJ, Peters DH. Metformin. A review of its pharmacological properties and therapeutic use in non-insulin-dependent diabetes mellitus. Drugs 1995;49:721-749.
3. Lalau JD. Lactic Acidosis Induced by Metformin. Drug Saf 2010;33:727-740.
4. Oral M, Cakar Turan KS. Should renal replacement therapy be continuous or intermittent? Journal of the Turkish Society of Intensive Care 2010;8 Suppl 1:28-37
5. Uusalo P, Järvisalo MJ. Mortality and renal prognosis in isolated metformin-associated lactic acidosis treated with continuous renal replacement therapy and citrate-calcium-anticoagulation. Acta Anaesthesiol Scand. 2020;64:1305–1311.
6. Pea F, Viale P, Pavan F, Furlanut M. Pharmacokinetic considerations for antimicrobial therapy in patients receiving renal replacement therapy. Clin Pharmacokinet. 2007;46(12):997-1038. doi: 10.2165/00003088-200746120-00003.
7. Calello D, Liu KD, Wiegand TJ, et al. EXTRIP Workgroup. Extracorporeal Treatment for Metformin Poisoning: Systematic Review and Recommendations From the Extracorporeal Treatments in Poisoning Workgroup. Crit Care Med. 2015;43:1716-1730
8. Kindgen-Miles D, Bradenburger T, Dimski T. Regional citrate anticoagulation for continuous renal replacement therapy. Curr Opin Crit Care 2018; 24:450-454.

9. Oudemans-van Straaten HM, Kellum JA, Bellomo R. Clinical review: Anticoagulation for continuous renal replacement therapy - heparin or citrate? Critical Care 2011, 15:202
10. Jaber S, Paugam C, Futier E, et al. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet 2018; 392:31-40.