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 ind...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.展开更多
目的探讨阶段性血液净化联合黄芪治疗百草枯中毒的疗效。方法210例急性百草枯中毒患者随机分为对照组(n=108)和治疗组(n=102),对照组采用常规治疗,治疗组在常规治疗基础上加用阶移性血液净化联合黄芪制剂进行治疗,观察和比较2组患者的...目的探讨阶段性血液净化联合黄芪治疗百草枯中毒的疗效。方法210例急性百草枯中毒患者随机分为对照组(n=108)和治疗组(n=102),对照组采用常规治疗,治疗组在常规治疗基础上加用阶移性血液净化联合黄芪制剂进行治疗,观察和比较2组患者的器官功能损害情况、氧合指数、住院天数、病死率和总有效率及并发症发生率。结果治疗组肝、肾、心、肺功能损害发生率,MODS和并发症发生率、病死率,入院5 d氧合指数<200 mm Hg发生率呼吸机相关性肺炎发生率低于对照组,总有效率高于对照组,差异均有统计学意义(P<0.05)。结论对百草枯中毒用阶段性血液净化联合黄芪治疗,能明显提高患者生存率,减少病死率。展开更多
文摘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.
文摘目的探讨阶段性血液净化联合黄芪治疗百草枯中毒的疗效。方法210例急性百草枯中毒患者随机分为对照组(n=108)和治疗组(n=102),对照组采用常规治疗,治疗组在常规治疗基础上加用阶移性血液净化联合黄芪制剂进行治疗,观察和比较2组患者的器官功能损害情况、氧合指数、住院天数、病死率和总有效率及并发症发生率。结果治疗组肝、肾、心、肺功能损害发生率,MODS和并发症发生率、病死率,入院5 d氧合指数<200 mm Hg发生率呼吸机相关性肺炎发生率低于对照组,总有效率高于对照组,差异均有统计学意义(P<0.05)。结论对百草枯中毒用阶段性血液净化联合黄芪治疗,能明显提高患者生存率,减少病死率。
