RESUMEN
Se trataron 8 pacientes intoxicados por diferentes métodos: hemoperfusión, hemodiálisis, diálisis peritoneal afectados de diferentes tóxicos (se desarrolla botulismo, bromato de potasio y metanol), se discuten las indicaciones de tratamiento
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Intoxicación/terapia , Botulismo/terapia , Bromatos/envenenamiento , Hemoperfusión , Lesión Renal Aguda/etiología , Diálisis Peritoneal , Diálisis Renal , Fenformina/efectos adversos , Intoxicación/diagnóstico , Intoxicación/tratamiento farmacológico , Alprazolam/envenenamiento , Bromazepam/envenenamiento , Hemoperfusión/instrumentación , Hemoperfusión , Coma/etiología , Coma/terapia , Metanol/envenenamiento , Metanol/metabolismo , Glicoles de Etileno/envenenamiento , Metotrimeprazina/envenenamiento , Acidosis Láctica/etiología , Acidosis Láctica/tratamiento farmacológico , Acidosis Láctica/terapia , Barbitúricos/envenenamientoRESUMEN
Phenformin-induced lactic acidosis has been thought to be rare in India due to a high carbohydrate intake, use of suboptimal doses of phenformin and a lesser prevalence of alcoholism, as compared to Western countries. We studied the blood lactate levels of 31 non-insulin dependent diabetics (Group A) before and after treatment with phenformin, 75 mg/day for 4 weeks. Blood lactate rose significantly after treatment (mean +/- SEM 16.6 +/- 1.2 mg/dl to 30.7 +/- 2.2; p less than 0.01). Seven patients from this group had blood lactic acid level greater than 72 mg/dl. Six of these patients were restudied off treatment and after 4 weeks of phenformin therapy. The arterial blood pH, pCO2, pO2 and bicarbonate remained unchanged on treatment although a significant rise in blood lactic acid was reconfirmed in these 6 patients. Another group of 12 patients on phenformin for more than six months had significantly lower blood lactate levels as compared to group A (mean +/- SEM 20.2 +/- 1.8 mg/dl vs 30.7 +/- 2.2 mg/dl; p less than 0.01) indicating the possibility of a process of adaptation on prolonged treatment. This possibility was confirmed by a serial follow-up study of 11 patients for a 6 month period on phenformin therapy. A case of biguanide-induced lactic acidosis diagnosed and treated by us is described.