scholarly journals Etiology and Management of Acute Metabolic Acidosis: An Update

2020 ◽  
Vol 45 (4) ◽  
pp. 523-531
Author(s):  
Igor Matyukhin ◽  
Susann Patschan ◽  
Oliver Ritter ◽  
Daniel Patschan
Keyword(s):  
Metabolic Acidosis ◽  
Lactic Acidosis ◽  
Critically Ill ◽  
Electrolyte Solutions ◽  
Carbon Dioxide Production ◽  
Intracellular Acidosis ◽  
Systemic Hypoxia ◽  
Life Threatening ◽  
Acute Metabolic Acidosis ◽  
The Moment

Background: The etiology of acute metabolic acidosis (aMA) is heterogeneous, and the consequences are potentially life-threatening. The aim of this article was to summarize the causes and management of aMA from a clinician’s perspective. Summary: We performed a systematic search on PubMed, applying the following search terms: “acute metabolic acidosis,” “lactic acidosis,” “metformin” AND “acidosis,” “unbalanced solutions” AND “acidosis,” “bicarbonate” AND “acidosis” AND “outcome,” “acute metabolic acidosis” AND “management,” and “acute metabolic acidosis” AND “renal replacement therapy (RRT)/dialysis.” The literature search did not consider diabetic ketoacidosis at all. Lactic acidosis evolves from various conditions, either with or without systemic hypoxia. The incidence of metformin-associated aMA is actually quite low. Unbalanced electrolyte preparations can induce hyperchloremic aMA. The latter potentially worsens kidney-related outcome parameters. Nevertheless, prospective and controlled data are missing at the moment. Recently, bicarbonate has been shown to improve clinically relevant endpoints in the critically ill, even if higher pH values (>7.3) are targeted. New therapeutics for aMA control are under development, since bicarbonate treatment can induce serious side effects. Key Messages: aMA is a frequent and potentially life-threatening complication of various conditions. Lactic acidosis might occur even in the absence of systemic hypoxia. The incidence of metformin-associated aMA is comparably low. Unbalanced electrolyte solutions induce hyperchloremic aMA, which most likely worsens the renal prognosis of critically ill patients. Bicarbonate, although potentially deleterious due to increased carbon dioxide production with subsequent intracellular acidosis, improves kidney-related endpoints in the critically ill.

Lactic acidosis in diabetes mellitus in the practice of a family doctor

2020 ◽  
pp. 37-43
Author(s):  
Vsevolod Skvortsov ◽  
Ekaterina Skvortsova ◽  
Georgiy Malyakin ◽  
Elina Goliyeva
Keyword(s):  
Diabetes Mellitus ◽  
Lactic Acid ◽  
Metabolic Acidosis ◽  
Lactic Acidosis ◽  
Chronic Hypoxia ◽  
Pathological Condition ◽  
Family Doctor ◽  
The Body ◽  
Anion Gap ◽  
The Moment

Lactic acidosis is a metabolic acidosis with a large anion gap (> 10 mmol/L) and a level of lactic acid in the blood > 4 mmol/L (according to some definitions, more than 2 mmol/L). This is a critical pathological condition of the body, accompanied by acute or chronic hypoxia, and even coma. The prognosis for the development of this condition is always severe, mortality is 50–80 %. Clear criteria for the diagnosis and treatment of this pathological condition are defined at the moment. This article focuses on the main issues that endocrinologists and resuscitators may encounter when identifying this complex of symptoms.

scholarly journals Severe metabolic acidosis in critically Ill patients and its association with the outcome in North Karnataka

2021 ◽  
Vol 8 (3) ◽  
pp. 395
Author(s):  
S. M. Biradar ◽  
Renuka Holyachi ◽  
V. Ravi Teja
Keyword(s):  
Metabolic Acidosis ◽  
Lactic Acidosis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Stable Condition ◽  
Rational Approach ◽  
Apache Ii Score ◽  
Strong Ion Gap ◽  
Severe Metabolic Acidosis ◽  
Vasopressor Support

Background: Outcomes of metabolic acidosis remain unsure and needs to be explored deeply. This article presents a rational approach to diagnosis and management of metabolic acidosis. The data focusing specifically on severe metabolic acidosis (pH<7.20) is scanty.  Methods: It was a prospective observational study. A total of 50 consecutive critically ill patients (APACHE II score of 18 or more) with single severe metabolic acidosis (pH<7.20) admitted to the intensive care units (ICUs) of Shri BM Patil Medical College, Vijayapura. Arterial blood gas analysis along with other relevant investigations was done within first 24 h of ICU admission.Results: Among 50 patients, 32 patients expired compared to 18 patients who were discharged from hospital in stable condition. Out of 29 patients, who had lactic acidosis, 21 (72%) patients died compared to 8 (28%) patients who were discharged in stable condition. Out of 22 patients who have low Strong Ion Difference (SID) 16 patients had expired (76%) remaining 6 (24%) patients are discharged at stable condition. Out of 27 patients who were put on mechanical ventilator on the first day, 22 (80%) patients expired. 18 patients required vasopressor support on admission out of which 16 (90%) patients had lactic acidosis.  Conclusions: Lactic acidosis and strong ion gap are found to be associated with higher mortality. Hypotensive patients required vasopressor support on admission. Monitoring of serum pH, HCO3−, lactate levels and strong ion gap may have prognostic and therapeutic implications. 

Proposal for the administration of metformin in patients with chronic kidney disease

2012 ◽  
Vol 153 (39) ◽  
pp. 1527-1535 ◽  
Author(s):  
Zoltán Balogh ◽  
János Mátyus
Keyword(s):  
Lactic Acidosis ◽  
Chronic Renal Disease ◽  
Antidiabetic Agent ◽  
First Line ◽  
Oral Antidiabetic Agent ◽  
Oral Antidiabetic ◽  
Cardiovascular Morbidity And Mortality ◽  
Glomerular Filtrate ◽  
Life Threatening

Metformin is the first-line, widely used oral antidiabetic agent for the management of type 2 diabetes. There is increasing evidence that metformin use results in a reduction in cardiovascular morbidity and mortality, and might have anticancer activity. An extremely rare, but potentially life-threatening adverse effect of metformin is lactic acidosis, therefore, its use is traditionally contraindicated if the glomerular filtrate rate is below 60 mL/min. However, lactic acidosis is always associated with acute events, such as hypovolemia, acute cardiorespiratory illness, severe sepsis and acute renal or hepatic failure. Furthermore, administration of insulins and conventional antihyperglycemic agents increases the risk of severe hypoglycemic events when renal function is reduced. Therefore, the magnitude of the benefit of metformin use would outweigh potential risk of lactic acidosis in moderate chronic renal disease. After reviewing the literature, the authors give a proposal for the administration of metformin, according to the calculated glomerular filtrate rate. Orv.Hetil., 2012, 153, 1527–1535.

scholarly journals Penetration of Isavuconazole in Ascites Fluid of Critically Ill Patients

2021 ◽  
Vol 7 (5) ◽  
pp. 376
Author(s):  
Tobias Lahmer ◽  
Gonzalo Batres Baires ◽  
Roland M. Schmid ◽  
Johannes R. Wiessner ◽  
Jörg Ulrich ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Ascites Fluid ◽  
Candida Spp ◽  
Fungal Peritonitis ◽  
Penetration Ratio ◽  
Threatening Condition ◽  
Liquid Chromatography Tandem Mass ◽  
Life Threatening ◽  
Fluid Levels

Fungal peritonitis is a life-threatening condition which is not only difficult to diagnose, but also to treat. Following recent guidelines, echinocandins and azoles are the recommended antimycotics for the management of intra-abdominal Candida spp. infections, with a favor for echinocandins in critically ill patients. However, the new extended spectrum triazole isavuconazole also has a broad spectrum against Candida spp. Data on its target-site penetration are sparse. Therefore, we assessed isavuconazole concentrations and penetration ratios in ascites fluid of critically ill patients. Obtaining of Isavuconazole plasma and ascites fluid levels as well penetration ratios using paracentesis in critically ill patients. Isavuconazole concentrations were quantified in human plasma and ascites by a liquid chromatography/tandem mass spectrometry (LC-MS/MS) method. Isavuconazole concentrations in plasma and ascites fluid were measured in sixteen critically ill patients. Isavuconazol levels in ascites fluid (1.06 µg/mL) were lower than plasma levels (3.08 µg/mL). Penetration ratio was 36%. In two out of sixteen patients, Candida spp., in detail C. glabrata and C. tropicalis, could be isolated. Cmax/MIC Ratio in plasma of 560 for C. glabrata and 2166 for C. tropicalis could be observed. Following our results, isavuconazole penetrates into ascites. Successful treatment in Candida spp. peritonitis depends on pathogen susceptibility.

scholarly journals Lactic Acidosis in a Congenital Bone Marrow Failure Syndrome

2021 ◽  
pp. 1-4
Author(s):  
Fatima Farid Mir ◽  
Anjan Madasu ◽  
Hani Humad ◽  
Asim Noor Rana
Keyword(s):  
Bone Marrow ◽  
Mitochondrial Dna ◽  
Metabolic Acidosis ◽  
Lactic Acidosis ◽  
Liver Failure ◽  
Bone Marrow Failure ◽  
Disease Course ◽  
Bone Marrow Failure Syndrome ◽  
Severe Lactic Acidosis ◽  
End Stage

Fifteen-month-old male child, known to have a congenital bone marrow failure syndrome, presented in a state of shock with severe lactic acidosis following a brief episode of vomiting. Hospital stay was complicated by recurrent bouts of metabolic acidosis and progressive hepatic failure. Blood mitochondrial DNA sequencing revealed a large heteroplasmic 4,977 bp mitochondrial deletion (approximately 40% of all mitochondrial copies) suggestive of Pearson marrow-pancreas syndrome. By virtue of natural disease course, within a month of admission child succumbed to end-stage liver failure with multi-organ failure and died.

scholarly journals When a harmless procedure causes a life-threatening problem: a case report of metformin-associated lactic acidosis following a colonoscopy

2019 ◽  
Vol 36 (1) ◽  
pp. 22-24 ◽  
Author(s):  
Ana Pessoa ◽  
José Quintela ◽  
Sofia Tavares ◽  
Marta Marques ◽  
Joana Pereira ◽  
...  
Keyword(s):  
Case Report ◽  
Lactic Acidosis ◽  
Life Threatening

scholarly journals ACUTE METABOLIC ACIDOSIS: EFFECTS ON ARGININE IN VASOPRESSIN(AVP) RELEASE IN FETAL SHEEP

1984 ◽  
Vol 18 ◽  
pp. 137A-137A
Author(s):  
Daniel J Faucher ◽  
Tom Lowe ◽  
About Laptook ◽  
John C Porter ◽  
Charles R Rosenfeld
Keyword(s):  
Metabolic Acidosis ◽  
Fetal Sheep ◽  
Acute Metabolic Acidosis

scholarly journals Regulation of AE1 anion exchanger and H + -ATPase in rat cortex by acute metabolic acidosis and alkalosis

1997 ◽  
Vol 51 (1) ◽  
pp. 125-137 ◽  
Author(s):  
Ivan Sabolić ◽  
Dennis Brown ◽  
Stephen L. Gluck ◽  
Seth L. Alper
Keyword(s):  
Metabolic Acidosis ◽  
Anion Exchanger ◽  
Rat Cortex ◽  
Acute Metabolic Acidosis
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