Hiperpotasemia extrema no fatal en un caso de acidosis láctica por sobreingesta de metformina

We report a 74-year-old man with diabetes mellitus type 2 and hypertension, who recently underwent coronary bypass surgery due to severe triple vessel disease receiving cardiological and combined antidiabetic therapy, including metformin 4 g/day. He was admitted with abdominal pain, nausea, vomiting...

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Autores principales:	Díaz,Rienzi, Vega,Jorge, Goecke,Helmuth
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2015
Materias:	Acidosis, lactic Hyperkalemia Metformin
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000300016
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spelling	oai:scielo:S0034-988720150003000162015-08-11Hiperpotasemia extrema no fatal en un caso de acidosis láctica por sobreingesta de metforminaDíaz,RienziVega,JorgeGoecke,Helmuth Acidosis, lactic Hyperkalemia Metformin We report a 74-year-old man with diabetes mellitus type 2 and hypertension, who recently underwent coronary bypass surgery due to severe triple vessel disease receiving cardiological and combined antidiabetic therapy, including metformin 4 g/day. He was admitted with abdominal pain, nausea, vomiting, diarrhea and loss of consciousness. At admission, he was disoriented and agitated with signs of poor perfusion. His blood pressure was 80/70 mmHg, pulse rate 40 beats/min, respiratory rate 20-breaths/min, and axillary temperature 35°C. Biochemical profile revealed an extreme hyperkalemia of 15.4 mEq/L (double checked), elevated creatinine, uremia and brain natriuretic peptide; hypoglycemia (blood glucose 68 mg/dl) and normal C Reactive Protein. Arterial blood gases revealed severe lactic acidemia. The electrocardiogram showed sinus bradycardia, simple AV block, widened QRS with prominent T wave and prolonged QT. He was admitted to the Intensive Care Unit (ICU) with the suspicion of lactic acidosis associated with metformin, receiving fluid management, intravenous hypertonic glucose plus insulin and sodium bicarbonate, mechanical ventilation, vasopressor therapy, a temporary pacemaker lead, in addition to continuous venovenous hemodiafiltration. Two days later, the patient experienced a significant clinical improvement with normalization of the acid-base status, plasma lactate and potassium levels. On day 9, diuresis was recovered, creatinine and uremia returned to normal levels and the patient was discharged from the ICU.info:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.143 n.3 20152015-03-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000300016es10.4067/S0034-98872015000300016
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Acidosis, lactic Hyperkalemia Metformin
spellingShingle	Acidosis, lactic Hyperkalemia Metformin Díaz,Rienzi Vega,Jorge Goecke,Helmuth Hiperpotasemia extrema no fatal en un caso de acidosis láctica por sobreingesta de metformina
description	We report a 74-year-old man with diabetes mellitus type 2 and hypertension, who recently underwent coronary bypass surgery due to severe triple vessel disease receiving cardiological and combined antidiabetic therapy, including metformin 4 g/day. He was admitted with abdominal pain, nausea, vomiting, diarrhea and loss of consciousness. At admission, he was disoriented and agitated with signs of poor perfusion. His blood pressure was 80/70 mmHg, pulse rate 40 beats/min, respiratory rate 20-breaths/min, and axillary temperature 35°C. Biochemical profile revealed an extreme hyperkalemia of 15.4 mEq/L (double checked), elevated creatinine, uremia and brain natriuretic peptide; hypoglycemia (blood glucose 68 mg/dl) and normal C Reactive Protein. Arterial blood gases revealed severe lactic acidemia. The electrocardiogram showed sinus bradycardia, simple AV block, widened QRS with prominent T wave and prolonged QT. He was admitted to the Intensive Care Unit (ICU) with the suspicion of lactic acidosis associated with metformin, receiving fluid management, intravenous hypertonic glucose plus insulin and sodium bicarbonate, mechanical ventilation, vasopressor therapy, a temporary pacemaker lead, in addition to continuous venovenous hemodiafiltration. Two days later, the patient experienced a significant clinical improvement with normalization of the acid-base status, plasma lactate and potassium levels. On day 9, diuresis was recovered, creatinine and uremia returned to normal levels and the patient was discharged from the ICU.
author	Díaz,Rienzi Vega,Jorge Goecke,Helmuth
author_facet	Díaz,Rienzi Vega,Jorge Goecke,Helmuth
author_sort	Díaz,Rienzi
title	Hiperpotasemia extrema no fatal en un caso de acidosis láctica por sobreingesta de metformina
title_short	Hiperpotasemia extrema no fatal en un caso de acidosis láctica por sobreingesta de metformina
title_full	Hiperpotasemia extrema no fatal en un caso de acidosis láctica por sobreingesta de metformina
title_fullStr	Hiperpotasemia extrema no fatal en un caso de acidosis láctica por sobreingesta de metformina
title_full_unstemmed	Hiperpotasemia extrema no fatal en un caso de acidosis láctica por sobreingesta de metformina
title_sort	hiperpotasemia extrema no fatal en un caso de acidosis láctica por sobreingesta de metformina
publisher	Sociedad Médica de Santiago
publishDate	2015
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000300016
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Hiperpotasemia extrema no fatal en un caso de acidosis láctica por sobreingesta de metformina

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