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Diarrhea and Acute Renal Injury Culminating in Metformin-Induced lactic acidosis

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Open Journal of Nephrology 2023年第3期13卷 195-200页

作者： Kamel El-Reshaid Abdulmohsen Al-Bader Department of Medicine Faculty of Medicine Kuwait University Kuwait City Kuwait Department of Otolarygology Ministry of Health Kuwait City Kuwait

Background: Metformin (M) is an effective first-line hypoglycemic agent in obese type 2 diabetes mellitus due to its low cost and safety profile. The Case: A 66-year-man presented with shock due to lactic acidosis induced by M-supersaturation subsequent to acute renal failure following infective diarrhea. The drug has been used, by this patient, for >10 years without complication. Physical examination, laboratory tests, radiological investigations and blood cultures did not show evidence of new cardiac, hepatic and septic insult. Despite discontinuation of M and 2-days of aggressive hydration, bicarbonate infusions and pressors;toxic levels of the drug persisted and shock-state culminated in severe and oliguric renal failure with serum urea and creatinine up to 50 mmol/L and 1270 umol/L, respectively. Hence, continuous venovenous hemodiafiltration (CVVHDF) was used, for 16-hours, to remove the drug, correct his acidosis and support his severe renal complications. Hours after the procedure;drug level, lactic acidosis and its associated shock improved followed by gradual renal recovery. The patient was discharged after 6 days and serum creatinine reached his base line (180 umol/L) 2 weeks later. The drug was not recommended for his future use. Conclusion: M-induced lactic acidosis, should be considered in assessment of shock in M-treated patients and management of unstable patients indicates early-use of CVVHDF.

关键词： CVVHDF Diabetes Mellitus Diarrhea lactic acidosis Metformin Shock

Metformin associated lactic acidosis in Auckland City Hospital 2005 to 2009

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World Journal of Nephrology 2016年第4期5卷 367-371页

作者： Imad Haloob Janak R de Zoysa Department of Medicine Bathurst Base Hospital Department of Renal Medicine North Shore Hospital Waitemata Clinical School Faculty of Medicine and Health SciencesThe University of Auckland

AIM： To determine the incidence, clinical characteristics and outcomes of patients with metformin associated lactic acidosis （MALA）.METHODS： Auckland City Hospital drains a population of just over 400000 people. All cases presenting with metabolic acidosis between July 2005 and July 2009 were identifed using clinical coding. A retrospective case notes review identifed patients with MALA. Prescribing data for metformin was obtained from the national pharmaceutical prescribing ***： There were 42 cases of metabolic lactic acidosis over 1718000 patient years. There were 51000 patient years of metformin prescribed to patients over the study period. There were thirty two cases of lactic acidosis due to sepsis, seven in patients treated with metformin. Ten cases of MALA were identified. The incidence of MALA was estimated at 19.46 per 100000 patient year exposure to metformin. The relative risk of lactic acidosis in patients on metformin was 13.53 （95%CI： 7.88-21.66） compared to the general population. The mean age of patients with MALA was 63 years, range 40-83 years. A baseline estimated glomerular fltration rate was obtained in all patients and ranged from 23-130 mL/min per 1.73 m^2. Only two patients had chronic kidney disease *** patients required treatment with haemodialysis. Two patients died.

关键词： Acute kidney injury lactic acidosis Metformin

Acute esophageal necrosis caused by alcohol abuse

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World Journal of Gastroenterology 2005年第35期11卷 5568-5570页

作者： Tetsu Endo Juichi Sakamoto Ken Sato Miyako Takimoto Koji Shimaya Tatsuya Mikami Akihiro Munakata Tadashi Shimoyama Shinsaku Fukuda First Department of Internal Medicine Hirosaki University School of Medicine 5 Zaifucho Hirosaki Aomori 036-8562 Japan

Acute esophageal necrosis (AEN) is extremely rare and the pathogenesis of this is still unknown. We report a case of AEN caused by alcohol abuse. In our case, the main pathogenesis could be accounted for low systemic perfusion caused by severe alcoholic lactic acidosis. After the healing of AEN, balloon dilatation was effective to manage the stricture.

关键词： Esophagus lactic acidosis Alcohol drinking Balloon dilatation

Metformin does not improve survival in patients with hepatocellular carcinoma

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World Journal of Gastroenterology 2014年第42期20卷 15750-15755页

作者： Mamatha Bhat Roongruedee Chaiteerakij William S Harmsen Cathy D Schleck Ju Dong Yang Nasra H Giama Terry M Therneau Gregory J Gores Lewis R Roberts Division of Gastroenterology and Hepatology Mayo Clinic College of Medicine Division of Gastroenterology McGill University Health Centre Department of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital Thai Red Cross Society Division of Biomedical Statistics and Informatics Mayo Clinic College of Medicine

AIM: To assess whether metformin, which has a chemopreventive effect in chronic liver disease, has any chemotherapeutic effect in hepatocellular carcinoma.

关键词： Hepatocellular carcinoma Metformin Diabetes Survival Liver disease lactic acidosis

Severe and lethal adverse reactions of linezolid--a summary analysis of case reports

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Journal of Chinese Pharmaceutical Sciences 2022年第2期31卷 153-161页

作者： Yanyu Pei Jihui Hao Wenqi Duan Yujing Zheng Ming Zhao Liping Yang Department of Pharmacy Beijing No.6 HospitalBeijing 100007China Department of Pharmacy Beijing Xiaotangshan HospitalBeijing 100730China Department of Pharmacy Beijing HospitalNational Center of GerontologyBeijing 102211China

A systematic summary was used to evaluate case reports of adverse drug reactions(ADRs)caused by linezolid,and to explore the effects and severity on human organs or systems in the real *** databases,such as PubMed,Embase,Cochrane Library,and CINAHL,were searched using“linezolid”+“case reports”as search terms from the establishment of each database to 31 st December 2019,and the case reports on ADRs related to linezolid were collected.A total of 159 case reports were finally included in the analysis,including 189 *** ratio of male to female was 0.89:1,and the average age was(52.42±23.43)years *** results showed that linezolid-related severe ADRs mainly occurred in the nervous system(n=86)and blood system(n=44),followed by the metabolic system(n=31)and gastrointestinal system(n=18).Other systems reported less frequently were the skin tissue(n=6),renal and urinary system(n=3),cardiovascular systems(n=2),and hepatobiliary system(n=2).The most common linezolid-related ADRs were serotonin syndrome(n=40),followed by optic neuropathy(n=25)and thrombocytopenia(n=22).The most severe ADR was lactic acidosis(n=29),and its death rate was as high as 31.0%.In the blood system ADRs,11 cases had underlying diseases of renal impairment,and four of them ***,22 cases with thrombocytopenia were mainly elderly over 65 years old(n=17),and there were also one infant and one child with *** first reported that lactic acidosis and blood system ADRs mostly occurred within 28 d,and the nervous system ADRs mostly occurred after 28 ***,irreversible auditory neuropathy(n=1),hypophosphatemia(n=1),bradycardia(n=1),and tooth discoloration mostly occurring in minors(n=5)were the linezolid-related ADRs,which were not described in the instructions,related guidelines,and clinical trials of *** most severe linezolid-related ADRs was lactic acidosis that occurred within 28 *** damage and special populations might be the main risk factors in t

关键词： Linezolid Adverse drug reactions lactic acidosis Case reports