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Effect of high-flow high-volume-intermittent hemodiafiltration on metformin-associated lactic acidosis with circulatory failure: a case report
BACKGROUND: Metformin-associated lactic acidosis is a well-known life-threatening complication of metformin. We here report the case of a patient who developed metformin-associated lactic acidosis without organ manifestations, due to the simultaneous ingestion of an overdose of metformin and alcohol...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6162950/ https://www.ncbi.nlm.nih.gov/pubmed/30266098 http://dx.doi.org/10.1186/s13256-018-1809-6 |
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author | Suzuki, Kodai Okada, Hideshi Yoshida, Shozo Okamoto, Haruka Suzuki, Akio Suzuki, Keiko Yamada, Yuto Hayashi, Hideki Yasuda, Ryu Fukuta, Tetsuya Kitagawa, Yuichiro Miyake, Takahito Kawaguchi, Tomonori Watanabe, Takatomo Doi, Tomoaki Kumada, Keisuke Ushikoshi, Hiroaki Sugiyama, Tadashi Itoh, Yoshinori Ogura, Shinji |
author_facet | Suzuki, Kodai Okada, Hideshi Yoshida, Shozo Okamoto, Haruka Suzuki, Akio Suzuki, Keiko Yamada, Yuto Hayashi, Hideki Yasuda, Ryu Fukuta, Tetsuya Kitagawa, Yuichiro Miyake, Takahito Kawaguchi, Tomonori Watanabe, Takatomo Doi, Tomoaki Kumada, Keisuke Ushikoshi, Hiroaki Sugiyama, Tadashi Itoh, Yoshinori Ogura, Shinji |
author_sort | Suzuki, Kodai |
collection | PubMed |
description | BACKGROUND: Metformin-associated lactic acidosis is a well-known life-threatening complication of metformin. We here report the case of a patient who developed metformin-associated lactic acidosis without organ manifestations, due to the simultaneous ingestion of an overdose of metformin and alcohol, and who recovered with high-flow high-volume intermittent hemodiafiltration. CASE PRESENTATION: A 44-year-old Asian woman with type 2 diabetes attempted suicide by ingesting 10 tablets of metformin 500 mg and drinking approximately 600 mL of Japanese sake containing 15% alcohol. She was transferred to our emergency department because of disturbed consciousness. Continuous intravenous administration of noradrenalin (0.13 μg/kg per minute) was given because she was in shock. Laboratory findings included a lactate level of 119 mg/dL (13.2 mmol/L), bicarbonate of 14.5 mmol/L, and serum metformin concentration of 1138 ng/mL. She was diagnosed as having metformin-associated lactic acidosis worsened by alcohol. After 4560 mL of bicarbonate ringer (Na(+) 135 mEq/L, K(+) 4 mEq/L, Cl(−) 113 mEq/L, HCO(3)(−) 25 mEq/L) was administered, high-flow high-volume intermittent hemodiafiltration. (dialysate flow rate: 500 mL/min, substitution flow rate: 3.6 L/h) was carried out for 6 h to treat metabolic acidosis and remove lactic acid and metformin. Consequently, serum metformin concentration decreased to 136 ng/mL and noradrenalin administration became unnecessary to maintain normal vital signs. On hospital day 12, she was moved to the psychiatry ward. CONCLUSIONS: HFHV-iHDF may be able to remove metformin and lactic acid efficiently and may improve the condition of hemodynamically unstable patients with metformin-associated lactic acidosis. |
format | Online Article Text |
id | pubmed-6162950 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-61629502018-10-04 Effect of high-flow high-volume-intermittent hemodiafiltration on metformin-associated lactic acidosis with circulatory failure: a case report Suzuki, Kodai Okada, Hideshi Yoshida, Shozo Okamoto, Haruka Suzuki, Akio Suzuki, Keiko Yamada, Yuto Hayashi, Hideki Yasuda, Ryu Fukuta, Tetsuya Kitagawa, Yuichiro Miyake, Takahito Kawaguchi, Tomonori Watanabe, Takatomo Doi, Tomoaki Kumada, Keisuke Ushikoshi, Hiroaki Sugiyama, Tadashi Itoh, Yoshinori Ogura, Shinji J Med Case Rep Case Report BACKGROUND: Metformin-associated lactic acidosis is a well-known life-threatening complication of metformin. We here report the case of a patient who developed metformin-associated lactic acidosis without organ manifestations, due to the simultaneous ingestion of an overdose of metformin and alcohol, and who recovered with high-flow high-volume intermittent hemodiafiltration. CASE PRESENTATION: A 44-year-old Asian woman with type 2 diabetes attempted suicide by ingesting 10 tablets of metformin 500 mg and drinking approximately 600 mL of Japanese sake containing 15% alcohol. She was transferred to our emergency department because of disturbed consciousness. Continuous intravenous administration of noradrenalin (0.13 μg/kg per minute) was given because she was in shock. Laboratory findings included a lactate level of 119 mg/dL (13.2 mmol/L), bicarbonate of 14.5 mmol/L, and serum metformin concentration of 1138 ng/mL. She was diagnosed as having metformin-associated lactic acidosis worsened by alcohol. After 4560 mL of bicarbonate ringer (Na(+) 135 mEq/L, K(+) 4 mEq/L, Cl(−) 113 mEq/L, HCO(3)(−) 25 mEq/L) was administered, high-flow high-volume intermittent hemodiafiltration. (dialysate flow rate: 500 mL/min, substitution flow rate: 3.6 L/h) was carried out for 6 h to treat metabolic acidosis and remove lactic acid and metformin. Consequently, serum metformin concentration decreased to 136 ng/mL and noradrenalin administration became unnecessary to maintain normal vital signs. On hospital day 12, she was moved to the psychiatry ward. CONCLUSIONS: HFHV-iHDF may be able to remove metformin and lactic acid efficiently and may improve the condition of hemodynamically unstable patients with metformin-associated lactic acidosis. BioMed Central 2018-09-29 /pmc/articles/PMC6162950/ /pubmed/30266098 http://dx.doi.org/10.1186/s13256-018-1809-6 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Case Report Suzuki, Kodai Okada, Hideshi Yoshida, Shozo Okamoto, Haruka Suzuki, Akio Suzuki, Keiko Yamada, Yuto Hayashi, Hideki Yasuda, Ryu Fukuta, Tetsuya Kitagawa, Yuichiro Miyake, Takahito Kawaguchi, Tomonori Watanabe, Takatomo Doi, Tomoaki Kumada, Keisuke Ushikoshi, Hiroaki Sugiyama, Tadashi Itoh, Yoshinori Ogura, Shinji Effect of high-flow high-volume-intermittent hemodiafiltration on metformin-associated lactic acidosis with circulatory failure: a case report |
title | Effect of high-flow high-volume-intermittent hemodiafiltration on metformin-associated lactic acidosis with circulatory failure: a case report |
title_full | Effect of high-flow high-volume-intermittent hemodiafiltration on metformin-associated lactic acidosis with circulatory failure: a case report |
title_fullStr | Effect of high-flow high-volume-intermittent hemodiafiltration on metformin-associated lactic acidosis with circulatory failure: a case report |
title_full_unstemmed | Effect of high-flow high-volume-intermittent hemodiafiltration on metformin-associated lactic acidosis with circulatory failure: a case report |
title_short | Effect of high-flow high-volume-intermittent hemodiafiltration on metformin-associated lactic acidosis with circulatory failure: a case report |
title_sort | effect of high-flow high-volume-intermittent hemodiafiltration on metformin-associated lactic acidosis with circulatory failure: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6162950/ https://www.ncbi.nlm.nih.gov/pubmed/30266098 http://dx.doi.org/10.1186/s13256-018-1809-6 |
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