Dehesa-López E, Hernández-Quintero DA, Peña-Peredia HG, Salas-Zazueta RR, Tamayo-García B, Rochin-Terán JL

Language: Spanish
References: 17
Page: 415-420
PDF size: 427.44 Kb.

ABSTRACT

This paper reports the case of a 72-year-old female patient with type 2 diabetes mellitus treated with metformin. She was admitted for abdominal pain, diarrhea, fever and somnolence. The initial diagnoses were severe sepsis, acute kidney injury with dialysis criteria and severe lactic acidosis secondary to septic shock and metformin. The medical treatment was with crystalloid solutions, intravenous antibiotics, intravenous bicarbonate infusion, vasopressors, mechanical ventilation and hemodialysis. The clinical course was initially satisfactory; however, the patient persisted with severe hyperlactatemia despite 3 hemodialysis sessions, mean arterial pressure above 65 mmHg with minimum dose of vasopressor and normal liver function tests. In the control abdominal CT, multiple and extensive hepatic infarcts were documented secondary to hepatic artery thrombosis, not observed in the abdominal CT performed at hospital admission.

REFERENCES

1. Vernon C, Letourneau JL. Lactic acidosis: recognition, kinetics, and associated prognosis. Crit Care Clin 2010;26:255- 283.

2. Kraut JA, Madias NE. Lactic acidosis. N Engl J Med 2014;371:2309-19.

3. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock. Crit Care Med 2013;41:580-637.

4. Kraut JA, Madias NE. Treatment of acute metabolic acidosis: a pathophysiologic approach. Nat Rev Nephrol 2012;8:589-601.

5. Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis: a prospective, controlled clinical study. Ann Intern Med 1990;112:492-498.

6. Hood VL, Tannen RL. Protection of acid–base balance by pH regulation of acid production. N Engl J Med 1998;339:819-26.

7. Kim HJ, Son YK, An WS. Effect of sodium bicarbonate administration on mortality in patients with lactic acidosis: a retrospective analysis. PLoS One 2013;8(6):e65283.

8. Luft FC. Lactic acidosis update for critical care clinicians. J Am Soc Nephrol 2001;12:S15-S19.

9. Levraut J, Ciebiera JP, Jambou P, Ichai C, et al. Effect of continuous venovenous hemofiltration with dialysis on lactate clearance in critically ill patients. Crit Care Med 1997;25:58-62.

10. Seidowsky A, Nseir S, Houdret N, et al. Metformin-associated lactic acidosis: a prognostic and therapeutic study. Crit Care Med 2009;37(7):2191-6.

11. Bailey CJ, Turner RC. Drug therapy: metformin. N Engl J Med 1996;334:574-9.

12. Salpeter SR1, Greyber E, Pasternak GA, Salpeter EE. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev 2010; 14(4):1-10.

13. Inzucchi SE, Lipska KJ, Mayo H, Bailey CJ, McGuire DK. Metformin in patients with type 2 diabetes and kidney disease: a systematic review. JAMA 2014;312(24):2668-75.

14. Casserly B, Phillips GS, Schorr C, Dellinger RP, Townsend SR, et al. Lactate measurements in sepsis-induced tissue hypoperfusion: results from the surviving sepsis campaign database. Crit Care Med 2015;43(3):567-73.

15. O’Connor PJ, Buhac I, Balint JA. Spontaneous hepatic artery thrombosis with infarction of the liver. Gastroenterology 1976;70(4):599-601.

16. Francque S, Condat B, Asselah T, et al. Multifactorial aetiology of hepatic infarction: a case report with literature review. Eur J Gastroenterol Hepatol 2004;16(4):411-15.

17. Almouradi T, Riles W, Attar B. Isolated hepatic artery thrombosis leading to multiple liver infarcts in a non-transplant patient. Am J Case Rep 2014;8(15):382-7.