Akut Böbrek Hasarı Olgusunda Metformin İle İlişkili Laktik Asidoz

Öz

Metformin, tip 2 diyabetin birinci basamak tedavisinde önerilen bir oral anti-diyabetik ajandır. Laktik asidoz, nadir gözlenmekle birlikte, yüksek mortalite oranı nedeniyle ilacın en önemli yan etkisidir. Hipoksemi, sepsis, akut ve kronik böbrek hasarı, karaciğer yetmezliği ve kalp yetmezliği metformin ilişkili laktik asidoz (MALA) gelişimini kolaylaştırabilir. MALA’da erken tanı ve uygun tedavi morbidite ve mortaliteyi azaltmaktadır. 64 yaşındaki kadın hasta parkinsonizm bulguları nedeniyle nöroloji servisinde takip edilmekteyken üre kreatinin yüksekliği olması üzerine konsülte edildi. Bulantı kusma ve iştahsızlık şikayeti vardı. Vital bulguları stabildi. Sorgulandığında 6 senedir diyabetes mellitus için metformin tedavisi aldığı öğrenildi. Kan gazında artmış anyon açıklı metabolik asidoz ve laktik asit yüksekliği saptandı. Hastada akut böbrek hasarı zemininde gelişen MALA düşünülerek metformin kesildi. Hemodiyalize alındı ve destek tedavi uygulandı. Hastanın böbrek fonksiyonları 1 hafta sonra normale döndü.

Anahtar Kelimeler

• akut böbrek hasarı
• metformin
• laktik asidoz
• hemodiyaliz

Metformin-associated Lactic Acidosis in a Case of Acute Kidney Injury

Öz

Metformin is an oral anti-diabetic agent recommended in the first-line treatment of type 2 diabetes. Although lactic acidosis is rarely observed, it is the most important side effect due to its high mortality rate. Hypoxemia, sepsis, acute and chronic renal injury, hepatic insufficiency and heart failure can precipitate metformin-associated lactic acidosis (MALA). Early diagnosis and appropriate treatment reduce morbidity and mortality in MALA. A 64-year-old female patient was hospitalized in the neurology department due to signs of parkinsonism and was consulted due to increased urea and creatinine. She had nausea, vomiting and loss of appetite. Her vital signs were stable. When questioned, it was learned that she had been receiving metformin treatment for diabetes mellitus for 6 years. High anion gap metabolic acidosis and lactic acid elevation were found in blood gas. The patient was considered to have MALA in the setting of acute kidney injury. Metformin was discontinued. Hemodialysis and supportive treatment was administered. Recovery of the patient's renal functions was achieved after a week.

Anahtar Kelimeler

• acute kidney injury
• metformin
• lactic acidosis
• hemodialysis

Kaynakça

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