Kardiyopulmoner arrest ile sonuçlanan metformin ilişkili laktik asidoz: nadir bir olgu

Abstract

Metformin, tip 2 diabetes mellitus tedavisinde birinci basamak ajan olarak yaygın olarak kullanılan oral hipoglisemik bir ilaçtır. Son zamanlarda yapılan çalışmalarda, normal aralıkta hafif veya orta derecede böbrek yetmezliği olan hastaların metformin ilaç düzeyleri normal bulundu ve ayrıca laktat düzeyleri normal sınırlarda bulundu. Ancak, hastanın böbrek fonksiyonu, karaciğer yetmezliği veya akut enfeksiyonu kötüleşmesi durumunda klinik önemi artar. Bu durumlarda, ilaç seviyeleri, yaşamı tehdit eden laktik asidozu arttırabilir. Biz burada kardiyopulmoner arrest ile sonuçlanan bir metformin ilişkili laktik asidoz olgusunu sunuyoruz. 

Keywords

• Metformin,laktik asidoz,kardiyopulmoner arrest

Metformin associated lactic acidosis resulted in cardiopulmonary arrest: a rare case

Abstract

Metformin is an oral hypoglycemic drug which is commonly used as a first-line agent in the treatment of type 2 diabetes mellitus. In recent studies, metformin drug levels of the patients with mild or moderate renal impairment were found in normal range and also lactate levels were found in normal range. But it’s clinical importance increases when the patient had worsening renal function, hepatic insufficiency or acute infection. In these situations, drug levels can increase lactic acidosis leading to life threatening. Here we present a case of metformin associated lactic acidosis resulted in cardiopulmonary arrest. 

Keywords

• Metformin,lactic acidosis,cardiopulmonary arrest

References

1. 1. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2015;38: 140-9.2. DeFronzo R, Fleming GA, Chen K, et al. Metformin-associated lactic acidosis: current perspectives on causes and risk. Metabol Clin Experiment 2016;65: 20-9.3. Chiew AL, Wright DF, Dobos NM, et al. Massive metformin overdose. British J Clin Pharm 2018.4. Lipska KJ. Metformin use in patients with historical contraindications. Annals Int Med 2017; 166: 225-6.5. Bell S, Farran B, McGurnaghan S, et al. Risk of acute kidney injury and survival in patients treated with Metformin: an observational cohort study. BMC Nephrol 2017; 18: 163.6. Adam WR, O’Brien RC. A justification for less restrictive guidelines on the use of metformin in stable chronic renal failure. Diabet Med 2014;31:1032–8. 7. Vecchio S, Protti A. Metformin-induced lactic acidosis: no one left behind. Crit Care 2011;15:107.8. Duong JK, Furlong TJ, Roberts DM, The role of metformin in metformin-associated lactic acidosis (MALA): case series and formulation of a model of pathogenesis. Drug Saf 2013;36:733-46. doi: 10.1007/s40264-013-0038-6.9. Protti A, Gattinoni L. Case 23-2013: a 54-year-old woman with metformin toxicity. N Engl J Med. 2013;369(18):1768-9.10. Friesecke S, Abel P, Roser M, Felix SB, Runge S. Outcome of severe lactic acidosis associated with metformin accumulation. Crit Care 2010;14:R226.11. Renda F, Mura P, Finco G, Ferrazin F, Pani L, Landoni G. Metformin-associated lactic acidosis requiring hospitalization: a national 10 year survey and a systematic literature review. Eur Rev Med Pharmacol Sci 2013;17:45-9.12. Nguyen HL, Concepcion L. Metformin intoxication requiring dialysis. HemodialInt 2011; 15:68-71.13. Calello DP, Liu KD, Wiegand TJ, et al. Extracorporeal treatment for metformin poisoning: systematic review and recommendations from the Extracorporeal Treatments in Poisoning Workgroup. Crit Care Med 2015;43:1716-3014. Duong JK, Furlong TJ, Roberts DM, et al. The role of metformin in metformin associated lactic acidosis (MALA): case series and formulation of a model of pathogenesis. Drug Saf 2013;36:733-46.15. Salpeter SR, Greyber E, Pasternak GA, Salpeter EE. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev. 2010; 4:CD002967.16. Haloob I, de Zoysa JR. Metformin associated lactic acidosis in Auckland City Hospital 2005 to 2009. World J Nephrol 2016;5:367-71.