Acute and Critical Care

Case Report

A Case of Metformin-Induced Acute Kidney Injury without Lactic Acidosis: A Case Report: Hae Ryong Jeong, Jeong Im Choi, Jung Hwan Park, Sang Mo Hong, Joon Sung Park, Chang Beom Lee, Yong Soo Park, Dong Sun Kim, Woong Hwan Choi, You Hern Ahn; Korean J Crit Care Med. 2012;27(4):283-285.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.283

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Abstract PDF: Metformin is an oral antidiabetic drug in the biguanide class, which is used for type 2 diabetes. The side effects of metformin are mostly limited to digestive tract symptoms, such as diarrhea, flatulence and abdominal discomfort. The most serious potential adverse effect of metformin is lactic acidosis. A 51-year-old man was admitted due to hypoglycemia as a result of an overdose of antidiabetic drugs. He took massive dose of metformin. Conservative treatment failed for metabolic acidosis without lactic acidosis accompanied by acute kidney injury. Hemodialysis was executed to correct the high anion gap metabolic acidosis and acute kidney injury, and the patient recovered fully from metabolic acidosis. This case illustrates that the presence of clinical conditions, such as metformin-induced acute kidney injury and metabolic acidosis, can be developed without lactic acidosis. Prompt recognition of metabolic acidosis and early intervention with hemodialysis can result in a successful clinical outcome.

Original Articles

Influence of Blood Glucose Level on Acid-Base Balance: Kyoung Min Lee; Korean J Crit Care Med. 2009;24(1):17-21.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.17

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BACKGROUND
This study was performed to evaluate whether blood glucose concentrations have a significant influence on acid-base balance.
METHODS
We studied 157 adult patients who underwent intra-abdominal operations under general anesthesia. Postoperative blood samples were withdrawn from radial artery and blood glucose concentrations, gas values, and chemistry values were measured. All patients were divided into three groups according to the postoperative blood glucose level. The group 1 contained the patients who had postoperative blood glucose level lower than 126 mg/dl, the group 2, the patients with glucose level higher than 126 mg/dl, lower than 180 mg/dl, and the group 3, the patients with glucose level higher than 180 mg/dl.
RESULTS
Metabolic acidosis rate was significantly higher in group 3 than in group 1, group 2 and arterial blood pH was significantly lower in group 3 than that in group 1, group 2. Regression analysis showed that [H+] was correlated with blood glucose level. Strong ion difference (SID) was significantly lower in group 3 than group 1 and PaCO2 level was significantly lower in group 2 and group 3 than that in group 1. In regression analysis, there was a negative correlation between blood glucose concentration and SID. [H+] had a negative correlation with SID and PaCO2 was correlated with SID.
CONCLUSIONS
These findings suggest that blood glucose level affects acid-base balance and a disturbance in SID is accompanied with respiratory compensation.

Citations

Citations to this article as recorded by

Hidden chronic metabolic acidosis of diabetes type 2 (CMAD): Clues, causes and consequences
Hayder A. Giha
Reviews in Endocrine and Metabolic Disorders.2023; 24(4): 735. CrossRef
A Case of Metformin-Induced Acute Kidney Injury without Lactic Acidosis - A Case Report -
Hae Ryong Jeong, Jeong Im Choi, Jung Hwan Park, Sang Mo Hong, Joon Sung Park, Chang Beom Lee, Yong Soo Park, Dong Sun Kim, Woong Hwan Choi, You Hern Ahn
Korean Journal of Critical Care Medicine.2012; 27(4): 283. CrossRef

Influence of Unmeasured Anions Identified by Stewart Principle on the Length of Postoperative Hospital Stay: Kyoung Min Lee, Sung Ho Seo, Seung Yun Lee, Jun Geol Lee, Tae Yop Kim, Ka young Rhee; Korean J Crit Care Med. 2005;20(2):152-158.

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Abstract PDF: BACKGROUND
Calculation of the base excess (BE) and the anion gap (AG) is commonly used to identify the presence and to analyze the cause of metabolic acidosis in critically ill patients. However, the calculation of BE assumes normal water content, electrolytes, and albumin, changes in these values will change the calculated BE. Calculation of the AG does not control for changes in albumin and cannot distinguish plasma concentration changes of negatively charged protein (albumin) from that of other anions. Based on Stewart's physicochemical principles, Gilfix et al developed equations to calculate the BE caused by unmeasured anions (BEua) taking into account changes in free water, chloride, albumin, and PCO2 that theoretically should reflect metabolic changes better than the less complete biochemical measurements. This study was designed to evaluate the influence of BEua and other variables on the length of postoperative hospital stay. METHODS: The data from 100 consecutive patients were collected prospectively in patients who underwent intra-abdominal operations under general anesthesia and admitted to the adult intensive care unit. All samples were routine samples taken from arterial lines postoperatively and analyzed for arterial blood gas, plasma electrolytes, inorganic phosphates and albumin concentrations. BEua was calculated from the equations developed by Gilfix et al. We also calculated AGNa, K (Na++K+-Cl--HCO3-) and AGNa (Na+-Cl--HCO3-). Correlations between the length of postoperative hospital stay and these variables were studied using linear regression analysis.
RESULTS
BEua and BE were significantly correlated with the length of ICU stay (r=0.295, p<0.01 and r=0.249, p<0.05). Neither AGNa, K nor AGNa was correlated with the length of ICU stay. Significant correlation was observed between the length of postoperative hospital stay and BEua (r=0.316, p<0.01), BE (r=0.288, p<0.01), AGNa, K (r=0.284, p<0.01), and AGNa (r=0.263, p<0.05). CONCLUSIONS: In this study BEua was significantly correlated with the length of ICU stay and postoperative hospital stay compared with other variables. This finding suggests that BEua may be used as a more reliable predictor of outcome in ICU patients.

Case Report

Malignant Hyperthermia Syndrome: A case report: Ji Yeon Kim, Eun Jung Kwon, Mi Kyoung Lee, Sang Ho Lim, Suk Min Yoon, Young Seok Choi; Korean J Crit Care Med. 1997;12(1):85-88.

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Abstract PDF: Malignant hyperthermia (MH) is an inherited skeletal muscle disorder characterized by hypermetabolism, muscle rigidity, rhabdomyolysis, fever, metabolic acidosis and death if untreated. The syndrome is believed to result from abnormal control of intracellular calcium ions in the skeletal muscle: on exposure to certain anesthetics, calcium level is increased, and then it activates contractile processes and biochemical events that support muscle contraction. We experienced a MH of 2 years-old male who had release of sternocleidomastoid muscle due to torticolis under general anesthesia. Anesthesia was induced with thiopental and succinylcholine, maintained with enflurane, nitrous oxide and oxygen (2 volume%: 2 L/min: 2 L/min). After induction of anesthesia, his heart rate, end-tidal CO2 tension and body temperature had been gradually increased and then those were reached to maximal value of heart rate (160~170 BPM), end-tidal CO2 tension (60~70 mmHg) and body temperature (41degrees C) 55 minutes later. He was immediately managed with symptomatic treatment such as hyperventilation with oxygen, cooling, beta-blocker, sodium bicarbonate and diuretics, so he was survived without any sequelae.

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