Bone calcium changes during diabetic ketoacidosis: A comparison with lactic acidosis due to volume depletion

Bone ◽  
2005 ◽  
Vol 37 (1) ◽  
pp. 122-127 ◽  
Author(s):  
A. Kemal Topaloglu ◽  
Dincer Yildizdas ◽  
H. Levent Yilmaz ◽  
Neslihan O. Mungan ◽  
Bilgin Yuksel ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Diabetic Ketoacidosis ◽  
Volume Depletion ◽  
Bone Calcium

Metformin Associated Lactic Acidosis in Clinical Practice – A Case Series

2020 ◽  
Author(s):  
Philipp Schädle ◽  
Otto Tschritter ◽  
Monika Kellerer
Keyword(s):  
Renal Replacement Therapy ◽  
High Risk ◽  
Lactic Acidosis ◽  
Replacement Therapy ◽  
Risk Score ◽  
Risk Group ◽  
Case Series ◽  
Individual Risk ◽  
Volume Depletion ◽  
Screening Criteria

Abstract Aims The aim of this case report is to specify the frequency and mortality of Metformin-Associated Lactic Acidosis (MALA) in emergency medicine, as the diagnosis seems to occur more often than estimated. Methods To identify the subjects, we developed screening criteria for MALA. We measured the serum metformin concentration to confirm the diagnosis in all patients fulfilling these criteria. Retrospectively the patients were grouped according to individual risk (according to a defined risk score) and the application of renal replacement therapy. Results From 2013 until 2018 we were able to identify 11 MALA patients revealing a frequency of 1:4,000 emergency patients. Six patients survived and five died in the follow-up. All three patients in the high-risk group died although all of them received renal replacement therapy. In the low-risk group (three patients, one with renal replacement therapy), all patients survived, while in the intermediate-risk group (five patients, one with renal replacement therapy) three patients survived and two died. Additional severe comorbidities also contributed to mortality. Conclusions Every patient matching the screening criteria of acute renal failure, lactic acidosis and continued intake of metformin can be considered a potential MALA case. A risk score assessment which includes severe comorbidities may help to identify high-risk individuals and should be evaluated in larger studies.To prevent MALA, patients should be trained to immediately interrupt their own metformin use when showing signs of volume depletion. Physicians should be aware of the additional risk factors such as co-medication with diuretics, ACE (angiotensin converting enzyme) ACE inhibitors and NSAIDs (non steroidal anti inflammatory drugs).

Comparison of Perfusion and Volume Depletion Markers in Severe Pediatric Diabetic Ketoacidosis with and Without Acute Kidney Injury

2018 ◽  
Vol 42 (5) ◽  
pp. S14
Author(s):  
Rebecca Ronsley ◽  
Amanda Henderson ◽  
Mehima Kang ◽  
Peter Skippen ◽  
Cherry Mammen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Diabetic Ketoacidosis ◽  
Kidney Injury ◽  
Volume Depletion

Is lactic acidosis predictive of outcomes in pediatric diabetic ketoacidosis?

2020 ◽  
Vol 38 (2) ◽  
pp. 329-332 ◽  
Author(s):  
Matthew Cully ◽  
Amy D. Thompson ◽  
Andrew D. DePiero
Keyword(s):  
Lactic Acidosis ◽  
Diabetic Ketoacidosis

scholarly journals Tatalaksana Penurunan Kesadaran Pada Penderita Diabetes Mellitus

Medicinus ◽  
2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Ian Huang
Keyword(s):  
Diabetes Mellitus ◽  
Mortality Rate ◽  
Lactic Acidosis ◽  
Diabetic Ketoacidosis ◽  
Complications Of Diabetes ◽  
Uremic Encephalopathy ◽  
Hyperosmolar Hyperglycemic State ◽  
Life Threatening

Hyperglycemic crisis (diabetic ketoacidosis or hyperosmolar hyperglycemic state), lactic acidosis, hypoglycemia, and uremic encephalopathy are life-threatening complications of diabetes mellitus (DM). Specific therapies of each condition are essential in reducing mortality rate of the complications.

scholarly journals Metformin-Associated Acute Kidney Injury and Lactic Acidosis

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
David Arroyo ◽  
Rosa Melero ◽  
Nayara Panizo ◽  
Marian Goicoechea ◽  
Patrocinio Rodríguez-Benítez ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Lactic Acidosis ◽  
Renal Dysfunction ◽  
Rare Complication ◽  
Kidney Injury ◽  
Diabetic Patients ◽  
Related Factor ◽  
Volume Depletion ◽  
Oral Antidiabetic Agent

Objectives. Metformin is the preferred oral antidiabetic agent for type 2 diabetes. Lactic acidosis is described as a rare complication, usually during an acute kidney injury (AKI).Material and Methods. We conducted a prospective observational study of metformin-associated AKI cases during four years. 29 cases were identified. Previous renal function, clinical data, and outcomes were recorded.Results. An episode of acute gastroenteritis precipitated the event in 26 cases. Three developed a septic shock. Three patients died, the only related factor being liver dysfunction. More severe metabolic acidosis hyperkalemia and anemia were associated with higher probabilities of RRT requirement. We could not find any relationship between previous renal dysfunction and the outcome of the AKI.Conclusions. AKI associated to an episode of volume depletion due to gastrointestinal losses is a serious complication in type 2 diabetic patients on metformin. Previous renal dysfunction (mild-to-moderate CKD) has no influence on the severity or outcome.

scholarly journals Acute kidney injury caused by ammonium acid urate crystals in diabetic ketoacidosis at the onset of type 1 diabetes mellitus

2021 ◽  
Vol 2021 ◽  
Author(s):  
Shunsuke Shimazaki ◽  
Itsuro Kazukawa ◽  
Kyoko Mori ◽  
Makiko Kihara ◽  
Masanori Minagawa
Keyword(s):  
Acute Kidney Injury ◽  
Diabetic Ketoacidosis ◽  
Urine Volume ◽  
Kidney Injury ◽  
Recovery Phase ◽  
List Type ◽  
Volume Depletion ◽  
Urine Sediment ◽  
Ammonium Acid Urate ◽  
Urate Crystals

Summary Ammonium acid urate (AAU) crystals are rare in industrialized countries. Furthermore, the number of children with diabetic ketoacidosis (DKA) who develop severe acute kidney injury (AKI) after hospitalization is small. We encountered two patients with AKI caused by AAU crystals during the recovery phase of DKA upon admission. They were diagnosed with severe DKA and hyperuricemia. Their urine volume decreased and AKI developed several days after hospitalization; however, acidosis improved in both patients. Urine sediment analysis revealed AAU crystals. They were treated with urine alkalization and diuretics. Excretion of ammonia in the urine and urine pH levels increased after treatment of DKA, which resulted in the formation of AAU crystals. In patients with severe DKA, the urine and urine sediment should be carefully examined as AAU can form in the recovery phase of DKA. Learning points Ammonium acid urate crystals could be formed in the recovery phase of diabetic ketoacidosis. Diabetic ketoacidosis patients may develop acute kidney injury caused by ammonium acid urate crystals. Urine and urine sediment should be carefully checked in patients with severe DKA who present with hyperuricemia and volume depletion.

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