ABSTRACT
INTRODUCTION: Metformin is widely considered a first-line antiglycemic agent due to its cost-effectiveness and favorable adverse effect profile. However, its use is prohibited in patients with an estimated glomerular filtration rate <30 mL/min/1.73 m2 , due to the risk of potentially lethal metformin-associated lactic acidosis (MALA). We sought to evaluate MALA cases and outcomes at our institution. METHODS: In this observational, retrospective case series, we reviewed our EMR for all patients who had a metformin level drawn between January 2013 and May 2022 to identify individuals who met the diagnostic criteria for MALA. We evaluated risk factors for MALA, the relationship between metformin level, blood pH, serum bicarbonate, and lactate level and clinical outcomes of ventilator dependency, renal replacement therapy requirement, renal recovery in acute kidney injury (AKI) patients, and survival. FINDINGS: A total of 107 patients had metformin levels drawn, of which 19 patients met the diagnostic criteria for MALA. In our case series, MALA was primarily seen in AKI (15 patients) secondary to dehydration and sepsis, followed by end-stage renal disease (ESRD) (4 patients). Intubation was required in 17 patients, of whom 8 were successfully extubated after a mean duration of 14 days. Sixteen patients received renal replacement therapy (RRT). Intermittent hemodialysis (IHD) was performed in nine, continuous renal replacement therapy (CRRT) in four, and sequential therapy of IHD and CRRT in three patients. Seven patients, all in the AKI group (46.7%), died while all ESRD patients survived, accounting for an overall mortality rate of 36.8%. Among the eight surviving AKI patients, four had complete renal recovery with renal function returning to baseline, three had partial renal recovery, and one continued to require IHD at the time of discharge to a rehabilitation facility. DISCUSSION: MALA may be an underrecognized entity. A high level of clinical suspicion leading to prompt and aggressive treatment with RRT may improve mortality rates. Provider and patient education is of paramount importance for safe use of metformin.
Subject(s)
Acidosis, Lactic , Acute Kidney Injury , Kidney Failure, Chronic , Metformin , Humans , Metformin/adverse effects , Acidosis, Lactic/chemically induced , Acidosis, Lactic/therapy , Hypoglycemic Agents/adverse effects , Retrospective Studies , Renal Dialysis , Acute Kidney Injury/chemically induced , Acute Kidney Injury/therapyABSTRACT
RESUMEN Gran cantidad de dispositivos se han descripto con el objetivo de recolectar el efluente de una fístula enteroatmosférica. Podríamos resumir que existen dispositivos comerciales o artesanales; caros o accesibles; aspirativos y no aspirativos; que permiten la deambulación del paciente y aquellos que no colaboran con la movilidad posoperatoria. Cuando nos enfrentamos a esta patología, suelen ser varios los intentos de conseguir un dispositivo adecuado antes de encontrar el indicado para tal o cual paciente. Se presenta el caso de una mujer de 60 años con una fístula entero atmosférica en quienes el empleo del dispositivo del condón de Rivera permitió obtener un buen resultado.
ABSTRACT Many devices have been described to collect the effluent from an enteroatmospheric fistula. We can summarize that devices can be manufactured or handmade, expensive or affordable, or vacuum assisted or not. Additionally, they may allow the patient to ambulate or may not assist with postoperative mobility. When facing this condition, several attempts are typically made to obtain a suitable device before discovering the right one for each individual patient. We present the case of a 60-year- old woman with an enteroatmospheric fistula successfully managed using Rivera's condom technique.
ABSTRACT
Comparison of post-intensive care syndrome between critically ill survivors with or without coronavirus disease 2019 (CovP and CovN, respectively) showed that fewer CovP were able to return to work full time at >1â year and none at <1â year after discharge and that the majority of CovP survivors were able to work part time during both evaluation periods compared to CovN.
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RESUMEN Los infartos esplénicos son una causa infrecuente de dolor abdominal. Son causados por una amplia variedad de patologías. Presentamos el caso de un paciente en el que se hizo diagnóstico de infarto esplénico masivo secundario a una compresión extrínseca de un tumor quístico de páncreas.
ABSTRACT Splenic infarctions, a rare cause of abdominal pain, may be due to several conditions. We report the case of a male patient with a massive splenic infarction secondary to extrinsic compression from a pancreatic cystic tumor.
ABSTRACT
RESUMEN El carcinoma sebáceo es un tumor anexial raro que presenta un curso clínico agresivo con tendencia a la recurrencia local y metástasis a distancia. En el 75% de los casos se presenta en la región periocular, aunque puede aparecer en cualquier parte del cuerpo donde existan glándulas sebáceas. Presentamos un caso clínico de esta rara patología y su resolución.
ABSTRACT Sebaceous carcinoma is a rare and aggressive neoplasm derived from the adnexal epithelium of the sebaceous glands with a tendency to local recurrence and distant metastasis In 75% of cases the tumor develops in the periocular region but it can appear in any area with sebaceous glands. We report a case of this rare condition and its resolution.
