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1.
Rev. méd. Chile ; 145(8): 1072-1075, ago. 2017. graf
Article in Spanish | LILACS | ID: biblio-902587

ABSTRACT

Metformin-associated lactic acidosis is a severe and infrequent adverse event. Early diagnosis is essential to start an early treatment, which often has favorable results. We report a 56 years old non-insulin-requiring type 2 diabetic female who developed a severe metabolic acidosis associated with metformin in relation to an acute renal failure secondary to infectious diarrhea. Early treatment with bicarbonate and continuous hemofiltration allowed a quick improvement of the patient. Metformin-associated lactic acidosis has an elevated mortality (50-80%) and has a specific and effective treatment. Therefore, the condition must be born in mind.


Subject(s)
Humans , Female , Middle Aged , Acidosis, Lactic/chemically induced , Hypoglycemic Agents/adverse effects , Metformin/adverse effects , Bicarbonates/therapeutic use , Acidosis, Lactic/therapy , Hemofiltration/methods , Diabetes Mellitus, Type 2/drug therapy
2.
Arq. bras. med. vet. zootec. (Online) ; 69(3): 637-643, jun. 2017. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-846907

ABSTRACT

This study aimed to investigate the changes in the acid-base balance of sheep with experimentally induced acute ruminal lactic acidosis (ARA). Ten ewes orally received 15 grams of sucrose per kilogram of body mass. Arterial blood samples for blood gas analysis were obtained at the following intervals: before the induction of ARA (control), and 2, 4, 6, 8, 10, 12, 16, 20, 24, 28, 32, 36, 48, 72, 96, 120 and 144 hours after sucrose administration. Urine samples for pH measurement were obtained at the following times: -15 days, -7 days, and immediately before sucrose administration, then at 24, 48, 72, 96, 120 and 144 hours. Thereafter, both blood and urine samples were obtained on the 2nd, 3rd, and 4th following weeks. From 4 hours after the induction, elevation of the pH, bicarbonate and base excess on the arterial blood was observed. After 12 hours, the animals showed a decrease of these parameters, as well as urine acidification, which are symptomatic of metabolic acidosis. Within 28 hours, all parameters were normalized except the base excess, which only returned to normal after 72 hours. Despite the occurrence of acidemia, there was no need for medication and no animals died.(AU)


Este trabalho objetivou estudar as alterações referentes ao equilíbrio ácido-base de ovinos com acidose láctica ruminal aguda (ARA) induzida experimentalmente. Dez ovelhas receberam oralmente 15 gramas de sacarose por quilograma de peso corporal. Amostras de sangue arterial para realização da hemogasometria foram obtidas nos seguintes intervalos: antes da indução da ARA (controle), duas, quatro, seis, oito, 10, 12, 16, 20, 24, 28, 32, 36, 48, 72, 96, 120, 144 horas após a administração da sacarose. Amostras de urina para análise do pH urinário foram obtidas nos seguintes momentos: 15 dias, sete dias e imediatamente antes da administração da sacarose, 24, 48, 72, 96, 120 e 144 horas. Posteriormente, tanto as amostras de sangue quanto de urina foram obtidas na segunda, terceira e quarta semanas seguintes. A partir de quatro horas da indução, elevação do pH, do bicarbonato e excesso de base no sangue arterial foram observados. Após 12 horas, os animais apresentaram diminuição dos parâmetros acima citados, como também acidificação da urina, que são sintomas de acidose metabólica. Decorridas 28 horas, todos os parâmetros retornaram à normalidade, exceto o EB, que somente retornou à normalidade após 72 horas. Apesar da ocorrência da acidemia, não houve necessidade de tratamento medicamentoso e nenhum animal veio a óbito.(AU)


Subject(s)
Animals , Female , Acid-Base Equilibrium , Acidosis, Lactic/chemically induced , Ketosis/blood , Sheep , Blood Gas Analysis , Rumen/chemistry
3.
Rev. méd. Chile ; 143(3): 391-395, mar. 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-745638

ABSTRACT

We report a 74-year-old man with diabetes mellitus type 2 and hypertension, who recently underwent coronary bypass surgery due to severe triple vessel disease receiving cardiological and combined antidiabetic therapy, including metformin 4 g/day. He was admitted with abdominal pain, nausea, vomiting, diarrhea and loss of consciousness. At admission, he was disoriented and agitated with signs of poor perfusion. His blood pressure was 80/70 mmHg, pulse rate 40 beats/min, respiratory rate 20-breaths/min, and axillary temperature 35°C. Biochemical profile revealed an extreme hyperkalemia of 15.4 mEq/L (double checked), elevated creatinine, uremia and brain natriuretic peptide; hypoglycemia (blood glucose 68 mg/dl) and normal C Reactive Protein. Arterial blood gases revealed severe lactic acidemia. The electrocardiogram showed sinus bradycardia, simple AV block, widened QRS with prominent T wave and prolonged QT. He was admitted to the Intensive Care Unit (ICU) with the suspicion of lactic acidosis associated with metformin, receiving fluid management, intravenous hypertonic glucose plus insulin and sodium bicarbonate, mechanical ventilation, vasopressor therapy, a temporary pacemaker lead, in addition to continuous venovenous hemodiafiltration. Two days later, the patient experienced a significant clinical improvement with normalization of the acid-base status, plasma lactate and potassium levels. On day 9, diuresis was recovered, creatinine and uremia returned to normal levels and the patient was discharged from the ICU.


Subject(s)
Aged , Humans , Male , Acidosis, Lactic/chemically induced , Drug Overdose , Hyperkalemia/chemically induced , Hypoglycemic Agents/adverse effects , Metformin/adverse effects , /complications
5.
SJA-Saudi Journal of Anaesthesia. 2011; 5 (1): 73-75
in English | IMEMR | ID: emr-112972

ABSTRACT

Lactic acidosis is a recognized complication of the inhalant abuse such as toluene, especially in patients with renal insufficiency. We report a case of severe metabolic acidosis and hyperlactemia due to toluene sniffing. The favorable outcome, despite extremely poor clinical symptoms, signs, laboratory and radiological findings, was unexpected. Specific aspects of the clinical course are addressed. Toluene sniffing should be considered in evaluating sever metabolic acidosis. Favorable outcome could be achieved with early diagnosis and proper interventions


Subject(s)
Humans , Male , Acidosis, Lactic/chemically induced , Acidosis/chemically induced , Respiratory Distress Syndrome/chemically induced , Survival
7.
Rev. méd. Chile ; 136(1): 88-92, ene. 2008. tab
Article in Spanish | LILACS | ID: lil-483224

ABSTRACT

Propofol infusion syndrome (PRIS) is a rare but potentially lethal complications. This disorder is triggered under unknown circumstances by a propofol infusion of more than 5 mg/kg/h for more than 48 h. PRIS is characterized by a multiorgan failure and rhabdomyolysis and is induced by a disturbance in mitochondrial long chain fatty acid oxidation. We report a 43 year-old woman who underwent brain surgery due to a vascular malformation. In the immediate postoperative period, she had an unexplained and severe lactic acidosis. During anaesthesia, she received a propofol infusion of 7 mg/kg/h that continued in the UCI at a rate of 3.5 mg/kg/h, for 8 hours more. The suspicion of PRIS motivated immediate discontinuation of propofol with rapid correction of lactic acidosis and full recovery of the patient.


Subject(s)
Adult , Female , Humans , Acidosis, Lactic/chemically induced , Anesthetics, Intravenous/adverse effects , Hypnotics and Sedatives/adverse effects , Propofol/adverse effects , Acidosis, Lactic/diagnosis , Infusions, Intravenous , Intraoperative Complications/chemically induced , Time Factors
8.
Arq. neuropsiquiatr ; 65(3b): 848-851, set. 2007. graf
Article in English | LILACS, SES-SP | ID: lil-465194

ABSTRACT

We describe two Brazilian patients with HIV-associated neuromuscular weakness syndrome (HANWS), a unique clinical toxic syndrome that was recently reported in developed countries. Both patients were women, used stavudine and had hyperlactatemia, one of them with lactic acidosis. Eletrophysiological studies were consistent with axonal neuropathy. After discontinuation of antiretroviral therapy the patients had significant improvement in neurologic manifestations, and normalization of lactate levels. To our knowledge, this is the first report of HANWS in developing countries. Growing use of antiretroviral therapy in this setting, particularly stavudine, make it likely that similar cases will be observed.


Os autores descrevem dois pacientes brasileiros com a síndrome da fraqueza neuromuscular associada ao HIV, uma síndrome tóxica, clínicamente particular, que foi recentemente relatada em países desenvolvidos. Ambas pacientes eram do sexo feminino, usavam estavudina e apresentaram hiperlactatemia, uma delas com acidose láctica. Os exames electrofisiológicos foram consistentes com neuropatia axonal. As pacientes melhoraram significativamente das alterações neurológicas, assim como normalizaram os níveis de lactato, após descontinuar o uso dos antiretrovirais. Até onde sabemos, este é o primeiro relato da síndrome de fraqueza neuromuscular associada ao HIV em países em desenvolvimento. Nesse contexto, o uso crescente de antiretrovirais, particularmente a estavudina, possibilitarão que casos similares sejam observados.


Subject(s)
Adult , Female , Humans , Middle Aged , Acidosis, Lactic/chemically induced , Antiretroviral Therapy, Highly Active/adverse effects , HIV Infections/drug therapy , Muscle Weakness/chemically induced , HIV Infections/blood , Muscle Weakness/diagnosis , Viral Load
10.
Article in English | IMSEAR | ID: sea-91646

ABSTRACT

Highly active antiretroviral therapy (HAART) has resulted in dramatic declines in morbidity and mortality in HIV-I infected patients in the developed world. However, with the availability of generic antiretroviral treatments (ART) in India, a large number of patients now receive ART. Increase in experience with ART has led to the detection of drug-related toxicities. We report herein potentially fatal side effects associated with the use of nucleoside analogues in HIV treatment--hyperlactatemia and lactic acidosis/hepatic steatosis.


Subject(s)
Acidosis, Lactic/chemically induced , Adult , Antiretroviral Therapy, Highly Active/adverse effects , Dose-Response Relationship, Drug , Drug Therapy, Combination , Female , Follow-Up Studies , HIV Infections/diagnosis , Humans , India , Male , Middle Aged , Risk Assessment , Sampling Studies , Severity of Illness Index
11.
Article in English | WPRIM | ID: wpr-113958

ABSTRACT

Nucleoside reverse transcriptase inhibitors (NRTIs), which are used for the treatment of human immunodeficiency virus (HIV) infection have been associated with a wide spectrum of clinical manifestations, including hepatic steatosis, lipodystrophy, myopathy, and lactic acidosis. Such adverse effects are postulated to result from the inhibition of mitochondrial DNA gamma polymerase, which causes the depletion of mitochondrial DNA and eventual the disruption of oxidative phosphorylation. Although cases of severe decompensated lactic acidosis are rare, this syndrome is associated with a high mortality rate. We report upon the first Korean case, of severe lactic acidosis in an acquired immunodeficiency syndrome (AIDS) patient receiving stavudine, an anti-HIV drug.


Subject(s)
Acidosis, Lactic/chemically induced , Acquired Immunodeficiency Syndrome/drug therapy , Adult , Anti-HIV Agents/adverse effects , Female , Humans , Sodium Bicarbonate/therapeutic use , Stavudine/adverse effects
12.
Article in English | WPRIM | ID: wpr-182199

ABSTRACT

Metabolic and electrolyte abnormalities, including hypokalemia, hyperglycemia and lactic acidosis, are associated with theophylline overdose. However, we report an unusual case of sinus tachycardia, lactic acidosis, hypokalemia and hyperglycemia associated with the usual theophylline dose in a patient with asthma. The theophylline dose was 200 mg orally twice daily. Three hours after administration of the third dose, the patient experienced palpitation. An electrocardiogram showed a sinus tachycardia. Arterial blood gas analysis revealed a mixed metabolic acidosis and respiratory alkalosis. Serum lactate level was 51 mmol/L (normal 0.7~2.1 mmol/L). Biochemistry results were sodium 136 mEq/L, chloride 99 mEq/L, potassium 1.9 mEq/L and glucose 204 mg/dL. Our case suggests that a possibility of theophylline-associated metabolic abnormalities should be considered when an asthmatic patient given the usual theophylline dose presents with lactic acidosis, hypokalemia and hyperglycemia of unknown etiology.


Subject(s)
Acidosis, Lactic/chemically induced , Adult , Asthma/drug therapy , Bronchodilator Agents/administration & dosage , Female , Humans , Hyperglycemia/chemically induced , Hypokalemia/etiology , Tachycardia, Sinus/chemically induced , Theophylline/administration & dosage
13.
Rev. méd. Chile ; 128(10): 1139-43, oct. 2000. tab, graf
Article in Spanish | LILACS | ID: lil-277208

ABSTRACT

Type B lactic acidosis occurs without any evidence of cellular hypoxia and is associated with the use of drugs or toxins. We report a 36 years old woman with acquired immunodeficiency syndrome that was admitted to the hospital with a severe lactic acidosis. She had been treated with didanosine, stavudine and efavirenz for four months prior to admission. Despite the use of high bicarbonate doses and vasoactive drugs, the patient had a catastrophic evolution and died in shock and multiple organ failure, 68 hours after admission


Subject(s)
Humans , Female , Adult , Acidosis, Lactic/chemically induced , Anti-HIV Agents/adverse effects , Acquired Immunodeficiency Syndrome/complications , Lactic Acid/biosynthesis , Lactic Acid/metabolism , Acidosis, Lactic/diagnosis , Acidosis, Lactic/drug therapy , Anti-HIV Agents/pharmacology , Antiviral Agents/pharmacology , Didanosine/adverse effects , Acquired Immunodeficiency Syndrome/drug therapy , Stavudine/adverse effects
15.
Rev. bras. anestesiol ; 49(3): 151-9, maio-jun. 1999. tab, graf
Article in Portuguese | LILACS | ID: lil-277480

ABSTRACT

Justificativa e objetivos: a circulaçäo extracorpórea (CEC) pode reduzir a liberaçäo de oxigênio aos tecidos causando acidose metabólica lática. Os fármacos vasoativos utilizados frequentemente para controlar a pressäo arterial, modificam a resistência vascular periférica e podem interfirir na ocorrência da acidose lática. Os objetivos deste estudo foram: 1) determinar os fatores no desenvolvimento da acidose tipo A consequente à CEC; 2) avaliar os efeitos dos fármacos vasoativos como fatores coadjuvantes ou näo desta acidose. Método: participaram do estudo trinta pacientes submetios à revascularizaçäo do miocárdio e distribuídos em três grupos: I - näo utilizou agentes vasoativos; grupo II - utilizou epidefrina; grupo III - utilizou nitroprussiato de sódio e droperidol. Foram avaliados os parâmetros fisiológicos, oxigenaçäo tecidual, equilíbrio ácido-base e osmolalidade plasmática nos períodos: pré-CEC; CEC-32ºC; CEC-37ºC e pós-CEC. Resultados: o transporte e consumo de oxigênio foram reduzidos durante a CEC. Também ocorreu reduçäo significativa no pH arterial e bicarbonato plasmático associados ao aumento do lactato sanguíneo nos grupos I e II, durante e após a CEC. No grupo I as variaçöes destes parâmetros näo foram significativas quando conparados aos grupos II e III. A osmolalidade plasmática näo olterou significativamente nos grupos. Conclusäo: a acidose lática tipo A consequente à CEC, provalvelmente ocorreu por hipoperfusäo tecidual e näo hipoxemia. Foi observada acidose lática no grupo I devido aos efeitos da hipotermia, hemodiluiçäo e baixo fluxo de perfusäo. No grupo II, a norepinefrina parece ter acentuado a acidose lática tipo A. No grupo III, a administraçäo dos fármacos vasodilatodores durante a CEC parece ter contribuído favoravelmente com a redistribuiçäo do fluxo tecidual, prevenindo-se a acidose lática tipo A


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Acidosis, Lactic/chemically induced , Extracorporeal Circulation , Nitroprusside/adverse effects , Postoperative Complications , Thoracic Surgery , Cardiac Surgical Procedures , Vasodilator Agents/adverse effects
16.
Rev. Asoc. Med. Crit. Ter. Intensiva ; 10(2): 82-5, mar.-abr. 1996. tab
Article in Spanish | LILACS | ID: lil-180447

ABSTRACT

Introducción. El metformin puede desencadenar acidosis láctica en presencia de insuficiencia renal aguda. Objetivo. Reportar un caso de acidosis láctica secundaria a metformin en presencia de función renal normal. Reporte del caso. Un paciente de 45 años de edad con historia de diabetes mellitus no insulino-dependiente, tipo 2, ingresó a una ICU. Tenía vómito y debilidad después de 13 días de tratamiento con metformin (2,000 mg/d). Al ingreso tenía TA 80/40, FC 110/min. FR 32/min. Laboratorio: pH 6.77, PaCO2 10mmHg, PaO2 300 mmHg, glucosa 79 mg/dL, urea 191 mg/dL, creatinina 9.5 mg/dL, ácido láctico 34 mmol/L. Se realizaron maniobras enérgicas que incluyeron ventilación mecánica, administración de líquidos y diálisis peritoneal; se recuperó rápidamente y se dio de alta a su domicilio cinco días depués


Subject(s)
Humans , Male , Middle Aged , Acidosis, Lactic/etiology , Acidosis, Lactic/chemically induced , Biguanides/adverse effects , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/therapy , Metformin/administration & dosage , Metformin/adverse effects
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