A Diagnostic Dilemma "Cured" by Dialysis: An Educational Case Report.
Ryan J ChanChristopher McCuddenBrendan McCormickDeborah ZimmermanPublished in: Canadian journal of kidney health and disease (2023)
Maintain a broad differential diagnosis for patients presenting with a clinical syndrome consistent with an acute toxicity even if no culprit medications are identifiable on history, especially in patients with a suggestive social history.Anion-gap metabolic acidosis (AGMA) is common in hospitalized patients but sometimes requires further history and/or confirmatory testing to elucidate the root cause underlying typical causes of AGMA such as lactic acidosis or ketoacidosis.The main treatment of metformin toxicity is resuscitation and supportive care; however, metformin's biochemical properties make it readily dialyzable via either diffusion or convection.The Extracorporeal Treatments In Poisoning group recommends hemodialysis for metformin toxicity when there is a serum lactate >20 mmol/L, a blood pH <7.0, a failure of standard therapy, end-organ damage (hepatic or renal insufficiency), or a decreased level of consciousness.
Keyphrases
- case report
- oxidative stress
- healthcare
- chronic kidney disease
- end stage renal disease
- cardiac arrest
- liver failure
- palliative care
- peritoneal dialysis
- mesenchymal stem cells
- oxide nanoparticles
- ionic liquid
- acute respiratory distress syndrome
- respiratory failure
- drug induced
- hepatitis b virus
- intensive care unit
- septic shock
- cell therapy
- combination therapy
- cardiopulmonary resuscitation
- mechanical ventilation