ABSTRACT
Pz woman of 62 years comes to P.S.G. for fatigue, low-grade fever, diuresis present. A history of hypertension refers to therapy for about five years, diabetes mellitus for about two years in therapy with Metformin 1gr x 3 gg / day. Blood tests: BUN 195 mg / dL, creatinine 8.0 mg / dl, Ph 6877, HCO3 5.1 mmol / L BE -29.1 mmol / l. Rapid clinical deterioration with occurrence of arterial hypotension - 85/60 mmHg, stupor. Start therapy Bicarbonates ev, is positioned in Urgency CVC and it undergoes AFB with infusion of bicarbonates 2000 ml / h for 4 hours, blood flow rate 250 ml / min., the hemodynamics has been supported with dopamine infusion 200 mg: 2 vials in 250 cc of physiological vel 30 - 40 ml / h, The pc after undergoing three AFB, interrupted the dialysis for resumption of diuresis spontaneous and progressive improvement of renal function and blood pressure. Monitored, after discharge, the parameters of renal function decreased to within normal limits, clearance compatible with IRC II - III stage. CONCLUSIONS: dehydration, fever, IRC II stadium, undiagnosed caused, in a very short time, an accumulation of metformin, which has been the cause of metabolic acidosis. The pc. saved thanks to the positioning of the CVC and to the AFB in the treatment with the infusion of large quantities of Bicarbonates e.v. The use of metformin in pcs. > 50 years and / or creatinine clearance <60 ml / min., must be subordinated to the preliminary study and periodic renal function.
ABSTRACT
The patients in terminal uremia show anxiety and depression correlate with anagraphic and dialytic age, here evidenced trought the Hospital Anxiety and Depression Scale (HADS). In a cohort of 120 patients, only 100 have been selected, because of incompatibility (11.6%) or refusal (5%). The pool composed of 100 patients (59 men, 41 women; mean age of 70.8±12.07 years; 30% mean age of 74.27±3.12 and mean time on dialysis of 55.03±70.12 months, was treated with Bicarbonate High Flux, Hemodialysis Filtration(HDF), Hemofiltration Replacement (HFR), Acetate Free Hemofiltration (AFB), in Ultrapure, 40% in dialysis <24 months. Analyzing the data, the 58% (25% men, 33% women) presented level of anxiety and depression of IV° Likert, versus 16.6% of the general population. The correlation of variables indicates that among the patients under HD, the increase of anagraphyc age correlates with an increase at IV° of anxiety and depression, seen in 36% of patients with a mean age of 78.61± 5.95 (19% men, 17% women) and in 22% of patients with a mean age of 59.22± 8.43 (7% men, 15% women). Considering the dialytic time, the IV° itself correlates with patients under treatment <2 years, regardless for age. In fact 22% of these patients (8% man, 14% women - mean age of 69.31± 8.40) present a level of anxiety and depression worst than the population in longer treatment (87.36± 16.36 months), who instead represent 10% of the sample (3% men, 7% women -mean age 72.2± 11.24). This data can be read as a psychosomatic adaptation, but anymore as a consequence of the improvement of cenesthesy due to a personalized haemodialysis.
