New paradigm of oral rehydration in patients affected by irritable bowel syndrome with chronic diarrhea

Irritable bowel syndrome with diarrhea is a very frequent clinical condition characterized by disabling intestinal symptoms.This disease presents with daily abdominal pain for at least 3 months related to defecation and associated with a change in the frequency of bowel movements and the shape of the stool.International surveys about this disease report a global prevalence of about 1.5%.A new amino acid based electrolyte solution has recently been commercialized for oral rehydration in diarrhea.It is composed of water,electrolytes,and five selected amino acids that function as sodium co-transporters without containing glucose.In recent years,some studies explored the effectiveness of the amino acid based electrolyte beverage in oncologic patients with gastrointestinal mucositis,reporting good results.Recently,a prospective study to evaluate the clinical impact of the amino acid based medical beverage was conducted in patients with diarrhea predominant irritable bowel syndrome.The research was based on a real-life methodology minimizing the disruption of the routine care.One hundred patients suffering from irritable bowel syndrome with diarrhea drank a solution based on selected amino acids twice a day for 2 wk.Each enrolled patient completed the study and showed a significant response rate with regard to stool consistency and pain reduction.Based on this data,we can hypothesize that the amino acid based oral rehydration solution could be a valid tool in the treatment of patients affected by irritable bowel syndrome with diarrhea.It is certainly necessary to plan highquality clinical trials comparing glucose based oral solutions and amino acid based solutions in patients with persisting diarrhea.Probably in the near future all oral rehydration solutions will contain amino acids.

The protective role of prebiotics and probiotics on diarrhea and gut damage in the rotavirus-infected piglets

Rotavirus is one of the pathogenic causes that induce diarrhea in young animals, especially piglets, worldwide. However, nowadays, there is no specific drug available to treat the disease, and the related vaccines have no obvious efficiency in some countries. Via analyzing the pathogenesis of rotavirus, it inducing diarrhea is mainly due to disturb enteric nervous system, destroy gut mucosal integrity, induce intracellular electrolyte imbalance, and impair gut microbiota and immunity. Many studies have already proved that prebiotics and probiotics can mitigate the damage and diarrhea induced by rotavirus infection in hosts. Based on these, the current review summarizes and discusses the effects and mechanisms of prebiotics and probiotics on rotavirus-induced diarrhea in piglets. This information will highlight the basis for the swine production utilization of prebiotics and probiotics in the prevention or treatment of rotavirus infection in the future.

First identification of a novel Aichivirus D in goats with diarrhea

Kobuvirus comprises 6 officially recognized species,namely Aichivirus A-F,and can be further divided into 20 genotypes through VP1 gene phylogenetic analysis(https://ictv.global/report/chapter/picornaviridae/picornaviridae/kobuvirus).Aichivirus A in human,Aichivirus B in bovine,Aichivirus C in porcine and caprine,Aichivirus D in yak have been proved to be associated with diarrhea(Chen Y S et al.2013;Yang et al.2015;Zhu et al.2016;Zhai et al.2017;Wang et al.2020;Abi et al.2022;Yan et al.2023).

Lactose-free milk powder can effectively relieve diarrhea symptoms in weaning SD rats and children

Diarrhea has become the leading cause of illness and death among infants and young children in developing countries.Clinically,patients with diarrhea showed damaged intestinal epithelial villi,usually accompanied by lactase deficiency.In this study,we evaluated the therapeutic effects of lactose-free milk powder on rats and children with diarrhea.Antibiotic-associated diarrhea(AAD)model was established by gavage with antibiotic mixture in SD rats,followed by administration of milk powder containing lactose or not.The results showed that lactose-free milk powder ameliorated A AD-related diarrhea symptoms,and accelerated the recovery from diarrhea.And 16S sequencing results indicated lactose-free milk powder contributed to increase theα-andβ-diversity of intestinal flora,and restore the intestinal microbiota disorder.In conclusion,our data demonstrate that lactose-free milk powder could alleviate diarrhea by restoring gut microbiota and intestinal barrier function.

Transcriptome analysis suggests broad jejunal alterations in Linghu’s obesity-diarrhea syndrome:A pilot study

BACKGROUND Obesity is associated with a significantly increased risk for chronic diarrhea,which has been proposed as Linghu’s obesity-diarrhea syndrome(ODS);however,its molecular mechanisms are largely unknown.AIM To reveal the transcriptomic changes in the jejunum involved in ODS.METHODS In a cohort of 6 ODS patients(JOD group),6 obese people without diarrhea(JO group),and 6 healthy controls(JC group),high-throughput sequencing and bioinformatics analyses were performed to identify jejunal mucosal mRNA expression alterations and dysfunctional biological processes.In another cohort of 16 ODS patients(SOD group),16 obese people without diarrhea(SO group),and 16 healthy controls(SC group),serum diamine oxidase(DAO)and D-lactate(DLA)concentrations were detected to assess changes in intestinal barrier function.RESULTS The gene expression profiles of jejunal mucosa in the JO and JC groups were similar,with only 1 differentially expressed gene(DEG).The gene expression profile of the JOD group was significantly changed,with 411 DEGs compared with the JO group and 211 DEGs compared with the JC group,129 of which overlapped.The enrichment analysis of these DEGs showed that the biological processes such as digestion,absorption,and transport of nutrients(especially lipids)tended to be up-regulated in the JOD group,while the biological processes such as rRNA processing,mitochondrial translation,antimicrobial humoral response,DNA replication,and DNA repair tended to be down-regulated in the JOD group.Eight DEGs(CDT1,NHP2,EXOSC5,EPN3,NME1,REG3A,PLA2G2A,and PRSS2)may play a key regulatory role in the pathological process of ODS,and their expression levels were significantly decreased in ODS patients(P<0.001).In the second cohort,compared with healthy controls,the levels of serum intestinal barrier function markers(DAO and D-LA)were significantly increased in all obese individuals(P<0.01),but were higher in the SOD group than in the SO group(P<0.001).CONCLUSION Compared with healthy controls and obese individuals without diarrhea,patients with Linghu’s ODS had extensive transcriptomic changes in the jejunal mucosa,likely affecting intestinal barrier function and thus contributing to the obesity and chronic diarrhea phenotypes.

A CRISPR/Cas12a-based platform for rapid on-site bovine viral diarrhea virus diagnostics

Bovine viral diarrhea virus(BVDV)is a positive-sense single-stranded RNA virus,belonging to the genus Pestivirus in the Flaviviridae family(Riitho et al.2020).Currently,BVDV is divided into 3 main genotypes,BVDV-1,BVDV-2,and BVDV-3,based on the genetic differences in the 5′untranslated region(5′UTR)(Muasya et al.2022).

Calcium/calcimimetic via calcium-sensing receptor ameliorates cholera toxin-induced secretory diarrhea in mice

BACKGROUND Enterotoxins produce diarrhea through direct epithelial action and indirectly by activating the enteric nervous system.Calcium-sensing receptor(CaSR)inhibits both actions.The latter has been well documented in vitro but not in vivo.The hypothesis to be tested was that activating CaSR inhibits diarrhea in vivo.AIM To determine whether CaSR agonists ameliorate secretory diarrhea evoked by cholera toxin(CTX)in mice.METHODS CTX was given orally to C57BL/6 mice to induce diarrhea.Calcium and calci-mimetic R568 were used to activate CaSR.To maximize their local intestinal actions,calcium was administered luminally via oral rehydration solution(ORS),whereas R568 was applied serosally using an intraperitoneal route.To verify that their actions resulted from the intestine,effects were also examined on Cre-lox intestine-specific CaSR knockouts.Diarrhea outcome was measured biochemically by monitoring changes in fecal Cl-or clinically by assessing stool consistency and weight loss.RESULTS CTX induced secretory diarrhea,as evidenced by increases in fecal Cl-,stool consistency,and weight loss following CTX exposure,but did not alter CaSR,neither in content nor in function.Accordingly,calcium and R568 were each able to ameliorate diarrhea when applied to diseased intestines.Intestinal CaSR involvement is suggested by gene knockout experiments where the anti-diarrheal actions of R568 were lost in intestinal epithelial CaSR knockouts(villinCre/Casrflox/flox)and neuronal CaSR knockouts(nestinCre/Casrflox/flox).CONCLUSION Treatment of acute secretory diarrheas remains a global challenge.Despite advances in diarrhea research,few have been made in the realm of diarrhea therapeutics.ORS therapy has remained the standard of care,although it does not halt the losses of intestinal fluid and ions caused by pathogens.There is no cost-effective therapeutic for diarrhea.This and other studies suggest that adding calcium to ORS or using calcimimetics to activate intestinal CaSR might represent a novel approach for treating secretory diarrheal diseases.

Relationship between dietary fiber intake and chronic diarrhea in adults

BACKGROUND Dietary fiber is essential for human health and can help reduce the symptoms of constipation.However,the relationship between dietary fiber and diarrhea is,poorly understood.AIM To evaluate the relationship between dietary fiber and chronic diarrhea.METHODS This retrospective study was conducted using data from the United States National Health and Nutrition Examination Survey,conducted between 2005 and 2010.Participants over the age of 20 were included.To measure dietary fiber consumption,two 24-hour meal recall interviews were conducted.The independent relationship between the total amount of dietary fiber and chronic diarrhea was evaluated with multiple logistic regression and interaction analysis.RESULTS Data from 12829 participants were analyzed.Participants without chronic diarrhea consumed more dietary fiber than participants with chronic diarrhea(29.7 vs 28.5,P=0.004).Additionally,in participants with chronic diarrhea,a correlation between sex and dietary fiber intake was present:Women who consume more than 25 g of dietary fiber daily can reduce the occurrence of chronic diarrhea.CONCLUSION Dietary fiber can reduce the occurrence of chronic diarrhea.

Assessment of the triglyceride glucose index in adult patients with chronic diarrhea and constipation

BACKGROUND Accumulating evidence suggests that the gut microbiome is involved in the pathogenesis of insulin resistance(IR).However,the link between two of the most prevalent bowel disorders,chronic diarrhea and constipation,and the triglyceride glucose(TyG)index,a marker of IR,has not yet been investigated.AIM To investigate the potential association between TyG and the incidence of chronic diarrhea and constipation.METHODS This cross-sectional study enrolled 2400 participants from the National Health and Nutrition Examination Survey database from 2009-2010.TyG was used as an exposure variable,with chronic diarrhea and constipation as determined by the Bristol Stool Form Scale used as the outcome variables.A demographic investigation based on TyG quartile subgroups was performed.The application of multivariate logistic regression models and weighted generalized additive models revealed potential correlations between TyG,chronic diarrhea,and constipation.Subgroup analyses were performed to examine the stability of any potential associations.RESULTS In the chosen sample,chronic diarrhea had a prevalence of 8.00%,while chronic constipation had a prevalence of 8.04%.In multiple logistic regression,a more prominent positive association was found between TyG and chronic diarrhea,particularly in model 1(OR=1.45;95%CI:1.17-1.79,P=0.0007)and model 2(OR=1.40;95%CI:1.12-1.76,P=0.0033).No definite association was observed between the TyG levels and chronic constipation.The weighted generalized additive model findings suggested a more substantial positive association with chronic diarrhea when TyG was less than 9.63(OR=1.89;95%CI:1.05-3.41,P=0.0344),and another positive association with chronic constipation when it was greater than 8.2(OR=1.74;95%CI:1.02-2.95,P=0.0415).The results of the subgroup analyses further strengthen the extrapolation of these results to a wide range of populations.CONCLUSION Higher TyG levels were positively associated with abnormal bowel health.

Frequency of Rotavirus among under 5 Children Admitted to Wad Madani Pediatric Teaching Hospital with Diarrhea, Gezira State, Sudan (2021-2022)

Rotavirus is the leading cause of acute gastroenteritis and responsible for 20% of death in children under 5 years of age approximately 111 million episodes of gastroenteritis due to Rotavirus in under 5 children, which result in 25 million visits to clinic, 2 million hospitalization and 352,000 - 592,000 deaths. Children in the poorest countries account 82% of rotaviruses death. Diarrhea disease are major cause of death and disease among children under five years, a child on average suffers 2 to 3 attacks of diarrhea every year. Stools samples were collected from 196 children suffering from diarrhea and were tested for rotaviruses by immune chromatography test antigen (ICT-Ag), ELISA and RT PCR The data were analyzed using statistical package for the Social Sciences (SPSS). The results showed that prevalence of rotavirus was 26/196 (13.3%) by ICT Ag and ELISA and confirmed by RT-PC R. 87.8% of the children were vaccinated by Rota vaccine, 70% of their mothers not using soap for cleaning the children and thought diarrhea not infectious disease and believed it was caused by teething. In conclusion there was a decrease in prevalence of diarrhea by Rotavirus due to insertion of Rota vaccine in routine vaccination, rotavirus infection mostly occurs in poor family that not able to provide safe water and due to poor sanitation and low education of mother beside that some children suffered from malnutrition, so it recommended to incorporate ELISA as a diagnostic tool in routine diagnosis of rotavirus among children suffered from gastroenteritis.

Anti-Cancer Agents Associated Diarrhea:Current Status and Prospects

Cancer stands as one of the major threats to human life.Ensuring the safety of drugs is paramount,and the impact of adverse reactions on patients’quality of life and prognosis should not be underestimated.Diarrhea is a common clinical adverse event,and despite the absence of specific anti-diarrhea drugs,there is a pressing need for improvement.This article aims to provide a valuable reference for researchers in clinical drug use and scientific tumor treatment.It summarizes recent advancements in drug mechanisms and adverse reactions,whether in preclinical research or clinical diagnosis and therapy.

Clinical Thoughts and Cases of Jianpi Yishen Sechang Decoction Combined with Acupuncture in the Treatment of Functional Diarrhea

Functional diarrhea(FDr)accounts for a relatively high proportion of digestive diseases.It is an infection that is not accompanied by abdominal pain and shows negative results in laboratory tests for bacteria and viruses.The main symptoms are persistent or recurrent discharge of watery and soft stools.The course of the disease is prolonged and recurring,and the treatment cost is higher and greatly affects the patient’s daily life.The incidence rate has a gradual increase in the trend.Its pathogenesis is complex where Western medicine is mostly used in symptomatic drug treatment.The treatment can be fast-acting and effective in relieving diarrhea.However,the long-term use of Western medicine poses a high risk in terms of side effects and a high chance of recurring upon stopping medication.At the same time,some diarrhea patients show the existence of drug-resistant strains of bacteria,and the overall efficacy of the drug is limited.Chinese medicine is mild and able to provide excellent treatment of diarrhea.With its lower price and cost,most families can afford it.Fengliang Tian,director of traditional Chinese medicine,implemented the“needle and medicine”method,which combines medicine and acupuncture,involving the usage of Jianpi Yishen Sechang Decoction and acupuncture in the treatment of functional diarrhea.The method has a low price,fewer side effects,is easy to accept,and can significantly reduce the recurrence rate with high efficacy.The study would like to share the clinical thinking and cases as follows to provide ideas and methods for the treatment of functional diarrhea by traditional Chinese medicine.

Current Research Status of Traditional Chinese Medicine External Treatment for Diarrhea Type Irritable Bowel Syndrome

Irritable bowel syndrome(IBS-D)with diarrhea is a common gastrointestinal functional disease in clinical practice,which seriously affects the quality of life of patients.Cur‐rently,Western medicine has poor therapeutic effects,while traditional Chinese medi‐cine has unique advantages in relieving IBS-D symptoms and preventing recurrence.In recent years,especially with external treatment of traditional Chinese medicine,it has become a new treatment direction in clinical practice and has achieved good therapeutic effects.This article will provide a review of recent research on the treatment of IBS-D using traditional Chinese medicine external treatment methods.

Fecal microbiota dynamics and its relationship to diarrhea and health in dairy calves

Background:Diarrhea is a major cause of morbidity and mortality in young calves,resulting in considerable economic loss for dairy farms.To determine if some gut microbes might have resistance to dysbiotic process with calf diarrhea by dictating the microbial co-occurrence patterns from birth to post-weaning,we examined the dynamic development of the gut microbiota and diarrhea status using two animal trials,with the first trial having 14 Holstein dairy calves whose fecal samples were collected 18 times over 78 d from birth to 15 d post-weaning and the second trial having 43 Holstein dairy calves whose fecal samples were collected daily from 8 to 18 days of age corresponding to the first diarrhea peak of trial 1.Results:Metataxonomic analysis of the fecal microbiota showed that the development of gut microbiota had three age periods with birth and weaning as the separatrices.Two diarrhea peaks were observed during the transition of the three age periods.Fusobacteriaceae was identified as a diarrhea-associated taxon both in the early stage and during weaning,and Clostridium_sensu_stricto_1 was another increased genus among diarrheic calves in the early stage.In the neonatal calves,Prevotella_2(ASV4 and ASV26),Prevotella_9(ASV43),and Alloprevotella(ASV14)were negatively associated with Clostridium_sensu_stricto_1(ASV48),the keystone taxa of the diarrhea-phase module.During weaning,unclassified Muribaculaceae(ASV28 and ASV44),UBA1819(ASV151),Barnesiella(ASV497),and Ruminococcaceae_UCG-005(ASV254)were identified being associated with non-diarrheic status,and they aggregated in the non-diarrhea module of co-occurrence patterns wherein unclassified Muribaculaceae(ASV28)and Barnesiella(ASV497)had a direct negative relationship with the members of the diarrhea module.Conclusions:Taken together,our results suggest that the dynamic successions of calf gut microbiota and the interactions among some bacteria could influence calf diarrhea,and some species of Prevotella might be the core microbiota in both neonatal and weaning calves,while species of Muribaculaceae might be the core microbiota in weaning calves for preventing calf diarrhea.Some ASVs affiliated with Prevotella_2(ASV4 and ASV26),Prevotella_9(ASV43),Alloprevotella(AVS14),unclassified Muribaculaceae(ASV28 and ASV44),UBA1819(ASV151),Ruminococcaceae_UCG-005(ASV254),and Barnesiella(ASV497)might be proper probiotics for preventing calf diarrhea whereas Clostridium_sensu_stricto_1(ASV48)might be the biomarker for diarrhea risk in specific commercial farms.

Dietary fibers with low hydration properties exacerbate diarrhea and impair intestinal health and nutrient digestibility in weaned piglets

Background:This study aimed to investigate the hydration properties of different-source fibrous materials by com-paring their water-binding capacity(WBC),water swelling capacity(WSC),viscosity,and in vivo effects of selected samples on growth performance,nutrient digestibility,diarrhea,and intestinal health in weaned piglets.Methods:A total of 13 commercially available fibrous materials were first compared in chemical composition and in vitro hydration property.Subsequently,40 weaned piglets were randomized to five experimental dietary groups(8 piglets per group):control diet(a basal diet without dietary fiber,CON),basal diet supplemented with 5%microcrys-talline cellulose(MCC),5%wheat bran(WB),5%Moringa oleifera leaf powder(MOLP),or 5%sugar beet pulp(SBP),fol-lowed by analyzing their growth performance and diarrhea rate in a 28-d experiment.After the feeding experiment,anaesthetized piglets were killed,and their intestinal and colon content or plasma samples were analyzed in nutrient digestibility,intestinal morphology,intestinal barrier,short-chain fatty acids(SCFAs),and bacterial population.Results:In vitro studies showed low hydration properties for WB and MCC,while medium hydration properties for MOLP and SBP.In vivo studies indicated that compared with medium hydration property groups,low hydration prop-erty groups showed(1)exacerbated diarrhea,impaired intestinal health,and reduced apparent fecal digestibility of dry matter,gross energy,acid detergent fiber,and neutral detergent fiber;(2)decreased SCFAs concentration and rela-tive levels of Lactobacillus and Bifidobacterium,but increased levels of Escherichia coli and Brachyspira hyodysenteriae in colon contents.Additionally,SBP showed optimal performance in reducing diarrhea and increasing SCFAs produc-tion.Correlation analysis revealed a positive correlation of fiber hydration properties with in vitro SCFAs production,and diarrhea index and nutrient digestibility were negatively and positively correlated with SCFAs levels in the colon contents of weaned piglets,respectively.Conclusions:Different-source dietary fibers varied in their hydration properties and impacts on diarrhea,microbial composition and SCFAs production in weaned piglets.WB and MCC could exacerbate diarrhea and impair nutrient digestibility,probably because their low hydration properties were detrimental to gut microbial homeostasis and fermentation.Our findings provide new ideas for rational use of fiber resources in weaned piglets.

Postoperative diarrhea in Crohn's disease:Pathogenesis,diagnosis,and therapy

Diarrhea is a frequent symptom in postoperative patients with Crohn’s diseases(CD),and several different mechanisms likely account for postoperative diarrhea in CD.A targeted strategy based on a comprehensive understanding of postoperative diarrhea is helpful for better postoperative recovery.

Clinical factors predicting rotavirus diarrhea in children:A crosssectional study from two hospitals

BACKGROUND Rotavirus is still a significant contributing morbidity and mortality in pediatric patients.AIM To look at clinical signs and symptoms and laboratory findings that can predict rotavirus gastroenteritis compared to non-rotavirus gastroenteritis.METHODS This was a cross-sectional study with medical records obtained from December 2015 to December 2019.Inclusion criteria for this study include all hospitalised pediatric patients(0-18 years old)diagnosed with suspected rotavirus diarrhea.The receiver operating curve and Hosmer-Lemeshow test would be used to assess the final prediction findings'calibration(goodness of fit)and discrimination performance.RESULTS This study included 267 participants with 187(70%)rotavirus-diarrhea cases.The patients were primarily male in both rotavirus(65.2%)and non-rotavirus(62.5%)groups.The median age is 1.33 years old(0.08-17.67 years old).Multivariate analysis shows that wet season(OR_(adj)=2.5;95%CI:1.3-4.8,Padj=0.006),length of stay(LOS)≥3 days(OR_(adj)=5.1;95%CI:1.4-4.8,Padj=0.015),presence of abdominal pain(OR_(adj)=3.0;95%CI:1.3-6.8,Padj=0.007),severe dehydration(OR_(adj)=2.9;95%CI:1.1-7.9,Padj=0.034),abnormal white blood cell counts(OR_(adj)=2.8;95%CI:1.3-6.0,Padj=0.006),abnormal random blood glucose(OR_(adj)=2.3;95%CI:1.2-4.4,Padj=0.018)and presence of fecal leukocytes(OR_(adj)=4.1,95%CI:1.7-9.5,Padj=0.001)are predictors of rotavirus diarrhea.The area under the curve for this model is 0.819(95%CI:0.746-0.878,P value<0.001),which shows that this model has good discrimination.CONCLUSION Wet season,LOS≥3 d,presence of abdominal pain,severe dehydration,abnormal white blood cell counts,abnormal random blood glucose,and presence of fecal leukocytes predict rotavirus diarrhea.

Identification of a novel astrovirus from intestinal tissue of a donkey foal with severe diarrhea in China

DEAR EDITOR,Astroviruses are known to cause gastroenteritis and diarrhea symptoms in various hosts.However,no information is currently available on any donkey astrovirus genome.In this study,we collected six intestinal samples from donkey foals that died of severe diarrhea on a donkey farm in Shandong Province,China,in 2021.Based on metagenomic nextgeneration sequencing,a nearly complete donkey astrovirus 1(DAstV-1)sequence was detected as the only possible diarrhea-related mammalian virus.

Effect of a Commercially Available Electrolyte Solution on Acute, Non-Specific Diarrhea in Dogs

Purpose: To determine if a commercially available electrolyte solution is safe and lessens the duration and severity of diarrhea in shelter dogs in stressful situations. Methods: In Experiment 1, six healthy beagles were administered the protocol-approved dose of the electrolyte solution to evaluate clinical, biochemical, or fecal microbiome changes. In Experiment 2, 22 dogs with small or large bowel diarrhea were randomized into one of three groups: the electrolyte solution and a prescription veterinary diet, a placebo and a prescription veterinary diet, or the electrolyte solution and a standard diet. A fecal score was assigned by trained, masked observers through Day 5 using the Purina 7-point fecal scoring system. All dogs were screened for enteric parasites by fecal flotation and the use of a fluorescence antibody assay for Giardia spp. cysts and Cryptosporidium spp. oocysts and all dogs that were parasitized were administered fenbendazole for five days. Results: In Experiment 1, all dogs tolerated the electrolyte solution with no vomiting or diarrhea noted and there was no evidence of negative effects on the gastrointestinal microbiome. In Experiment 2, 16 of the 22 dogs enrolled in the study had a normal stool the day after the first dose of the electrolyte solution, prescription diet, or placebo. All six dogs with the first day of normal stool detected after Day 1 were parasitized. When the days to normalcy were compared, the parasitized dogs had a significantly slower resolution (P = 0.018) than dogs with no parasites regardless of the other treatment group. Conclusions and Relevance: The results of the study suggest that this electrolyte solution is safe for use in dogs and that adding the electrolyte solution to a standard diet is equivalent to using a therapeutic diet alone or the electrolyte solution combined with a therapeutic diet.

Diarrhea and Acute Renal Injury Culminating in Metformin-Induced Lactic Acidosis

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.