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Hyperlactatemia

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https://www.readbyqxmd.com/read/29318219/extending-metformin-use-in-diabetic-kidney-disease-a-pharmacokinetic-study%C3%A2-in%C3%A2-stage-4-diabetic-nephropathy
#1
Ajith Munasinghe Dissanayake, Mark Christopher Wheldon, Jafar Ahmed, Christopher John Hood
Introduction: Metformin use in advanced chronic kidney disease is controversial. This study sought to examine the pharmacokinetics, safety, and efficacy of low-dose metformin in patients with type 2 diabetes and stage 4 chronic kidney disease. Methods: In this open-label, phase I trial, 3 consecutive cohorts (1, 2, and 3) of 6 patients each were recruited to receive 250-, 500-, or 1000-mg once-daily doses of metformin, respectively. All patients underwent a first-dose pharmacokinetic profile and weekly trough metformin concentrations for the duration of 4 weeks of daily therapy...
July 2017: KI Reports
https://www.readbyqxmd.com/read/29305402/metformin-treatment-in-patients-with-type-2-diabetes-and-chronic-kidney-disease-stages-3a-3b-or-4
#2
Jean-Daniel Lalau, Farshad Kajbaf, Youssef Bennis, Anne-Sophie Hurtel-Lemaire, Frans Belpaire, Marc E De Broe
OBJECTIVE: This study was conducted to define a safe, effective dose regimen for metformin in moderate and severe chronic kidney disease (CKD; stages 3A/3B and 4, respectively), after the lifting of restrictions on metformin use in patients with diabetes with moderate-to-severe CKD in the absence of prospective safety and efficacy studies. RESEARCH DESIGN AND METHODS: Three complementary studies were performed: 1) a dose-finding study in CKD stages 1-5, in which blood metformin concentrations were evaluated during a 1-week period after each dose increase; 2) a 4-month metformin treatment study for validating the optimal metformin dose as a function of the CKD stage (3A, 3B, and 4), with blood metformin, lactate, and HbA1c concentrations monitored monthly; and 3) an assessment of pharmacokinetic parameters after the administration of a single dose of metformin in steady-state CKD3A, 3B, and 4...
January 5, 2018: Diabetes Care
https://www.readbyqxmd.com/read/29279533/the-incidence-risk-factors-and-outcomes-of-hyperlactatemia-after-heart-transplantation
#3
Yasuhiro Hoshino, Osamu Kinoshita, Minoru Ono
Hyperlactatemia (HL) is associated with tissue hypoperfusion during cardiac surgery, which results in postoperative morbidity and mortality among patients undergoing cardiopulmonary bypass surgery. The aim of this study was to determine the incidence, risk factors, and outcome of HL after heart transplantation (HTx) in one of the largest Japanese single-center cohorts. We retrospectively studied the lactate levels in 49 patients who underwent HTx at the University of Tokyo Hospital from August 1, 2010 to November 30, 2015...
December 27, 2017: International Heart Journal
https://www.readbyqxmd.com/read/29206763/association-of-clinical-hypoperfusion-variables-with-lactate-clearance-and-hospital-mortality
#4
Jessica Londoño, César Niño, James Díaz, Carlos Morales, Jimmy León, Elisa Bernal, Cesar Vargas, Leonardo Mejía, Carolina Hincapié, Johana Ascuntar, Alba León, Fabián Jaimes
BACKGROUND: lactate has shown utility in assessing the prognosis of patients admitted to the hospital with confirmed or suspected shock. Some findings of the physical examination might replace it as screening tool. We asked to determine the correlation and association between clinical perfusion parameters and lactate at the time of admission; the correlation between the change in clinical parameters and lactate clearance after 6 and 24 hours of resuscitation and; the association between clinical parameters, lactate and mortality...
December 4, 2017: Shock
https://www.readbyqxmd.com/read/29183525/varying-presentations-and-outcomes-of-septic-shock-should-septic-shock-be-stratified
#5
RANDOMIZED CONTROLLED TRIAL
Youfeng Zhu, Haiyan Yin, Rui Zhang, Xiaoling Ye, Jianrui Wei
Recent studies have revealed there are three presentations of septic shock in patients: refractory hypotension without hyperlactatemia, hyperlactatemia without refractory hypotension, and both refractory hypotension and hyperlactatemia. In this study, we sought to identify differences in the outcomes of septic shock patients with these three presentations. We performed a secondary analysis of a large-scale, multicenter, controlled trial. The septic shock patients were categorized into the following three groups according to the presence or absence of refractory hypotension and hyperlactatemia: a hypotension group (refractory hypotension without hyperlactatemia), a hyperlactatemia group (hyperlactatemia without refractory hypotension), and a typical group (both refractory hypotension and hyperlactatemia)...
November 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/29176794/capillary-refill-time-during-fluid-resuscitation-in-patients-with-sepsis-related-hyperlactatemia-at-the-emergency-department-is-related-to-mortality
#6
Barbara Lara, Luis Enberg, Marcos Ortega, Paula Leon, Cristobal Kripper, Pablo Aguilera, Eduardo Kattan, Ricardo Castro, Jan Bakker, Glenn Hernandez
INTRODUCTION: Acute circulatory dysfunction in patients with sepsis can evolve rapidly into a progressive stage associated with high mortality. Early recognition and adequate resuscitation could improve outcome. However, since the spectrum of clinical presentation is quite variable, signs of hypoperfusion are frequently unrecognized in patients just admitted to the emergency department (ED). Hyperlactatemia is considered a key parameter to disclose tissue hypoxia but it is not universally available and getting timely results can be challenging in low resource settings...
2017: PloS One
https://www.readbyqxmd.com/read/29165910/retrospective-evaluation-of-the-prognostic-utility-of-plasma-lactate-concentration-base-deficit-ph-and-anion-gap-in-canine-and-feline-emergency-patients
#7
Casey J Kohen, Kate Hopper, Philip H Kass, Steven E Epstein
OBJECTIVE: To determine the association of plasma lactate concentration, pH, base deficit (BD), and anion gap (AG) in dogs and cats on presentation to an emergency room with outcome, and to compare the prognostic significance of hyperlactatemia with a concurrent metabolic acidosis with that of hyperlactatemia and a normal metabolic acid-base balance. DESIGN: Retrospective study. SETTING: University teaching hospital. ANIMALS: Five hundred sixty-six dogs and 185 cats that had venous blood gas analysis performed...
November 22, 2017: Journal of Veterinary Emergency and Critical Care
https://www.readbyqxmd.com/read/29144182/plasma-lyte-148-vs-hartmann-s-solution-for-cardiopulmonary-bypass-pump-prime-a-prospective-double-blind-randomized-trial
#8
Laurence Weinberg, Elizabeth Chiam, James Hooper, Frank Liskaser, Angela Kim Hawkins, Denise Massie, Andrew Ellis, Chong O Tan, David Story, Rinaldo Bellomo
BACKGROUND: The mechanisms of acid-base changes during cardiopulmonary bypass (CPB) remain unclear. We tested the hypothesis that, when used as CPB pump prime solutions, Plasma-Lyte 148 (PL) and Hartmann's solution (HS) have differential mechanisms of action in their contribution to acid-base changes. METHODS: We performed a prospective, double-blind, randomized trial in adult patients undergoing elective cardiac surgery with CPB. Participants received a CPB prime solution of 2000 mL, with either PL or HS...
November 1, 2017: Perfusion
https://www.readbyqxmd.com/read/29129343/prognostic-value-of-hyperlactatemia-and-lactate-clearance-after-mitral-valve-surgery
#9
Adam S Evans, Matthew A Levin, Hung-Mo Lin, Ken Lee, Menachem M Weiner, Anelechi Anyanwu, David H Adams, Alexander J C Mittnacht
OBJECTIVES: Blood lactate is frequently used to guide management in critically ill patients. In patients undergoing mitral valve surgery, an elevated lactate level is frequently observed; however, overall mortality is low. The authors hypothesized that hyperlactemia is not a useful predictor of poor outcomes in this patient population. The main aim of this study was to explore how blood lactate level and lactate clearance are associated with 30-day mortality and major adverse events in patients undergoing mitral valve surgery...
August 2, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29110345/pyometra-and-unilateral-uterine-horn-torsion-in-a-sheep
#10
J M Castillo, J C Dockweiler, S H Cheong, M Diel de Amorim
A 13-year-old Romanov sheep presented for evaluation of vaginal discharge, depression and anorexia. Blood work demonstrated mature neutrophilia and marked hyperlactatemia. Transrectal and transabdominal ultrasound revealed echogenic fluid (pus) within the uterus. Purulent uterine fluid culture yield Escherichia coli. A diagnosis of pyometra was made. After medical treatment without clinical improvement, an exploratory laparotomy was performed, and a 360-degree uterine left horn torsion was identified with the pyometra and multiple corpora lutea on both ovaries...
November 7, 2017: Reproduction in Domestic Animals, Zuchthygiene
https://www.readbyqxmd.com/read/29107479/clinical-factors-and-outcomes-of-dialysis-dependent-end-stage-renal-disease-patients-with-emergency-department-septic-shock
#11
Kevin M Lowe, Alan C Heffner, Colleen H Karvetski
BACKGROUND: Infection is the second leading cause of death in end-stage renal disease (ESRD) patients. Prior investigations of acute septic shock in this specific population are limited. OBJECTIVE: We aimed to evaluate the clinical presentation and factors associated with outcome among ESRD patients with acute septic shock. METHODS: We reviewed patients prospectively enrolled in an emergency department (ED) septic shock treatment pathway registry between January 2014 and May 2016...
October 26, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29100545/a-systematic-review-and-diagnostic-test-accuracy-meta-analysis-of-the-validity-of-anion-gap-as-a-screening-tool-for-hyperlactatemia
#12
Stella Andrea Glasmacher, William Stones
OBJECTIVE: This systematic review and meta-analysis seeks to determine the validity of the anion gap to screen for hyperlactatemia in critically ill patients. We have previously shown that the anion gap does not predict 31-day and in-hospital mortality in critically ill patients. The present review aims to add confirmatory evidence to identify whether the anion gap is a suitable tool for risk stratification in low-resource countries. RESULTS: Nine studies reporting on 4504 samples from 2111 patients were included...
November 3, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/29058235/risk-of-metformin-associated-lactic-acidosis-mala-in-patients-after-gastric-bypass-surgery
#13
Laura N Deden, Edo O Aarts, Stephanie C W Aelfers, Marcel M G J van Borren, Ignace M C Janssen, Frits J Berends, Hans de Boer
BACKGROUND: Pharmacokinetic data suggest that the risk of metformin-associated lactic acidosis (MALA) may be increased after Roux-en-Y gastric bypass (RYGB) surgery. The aim of this study was to examine the impact of metformin on plasma lactate levels before and after RYGB surgery. METHODS: Retrospective study of plasma lactate levels before and 3 months after RYGB surgery in patients with type 2 diabetes mellitus (T2DM) not using metformin (MET-0, N = 58), on a stable dose (MET-S, N = 138), or on a decreasing dose (MET-D, N = 85) of metformin...
October 23, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/29047411/mildly-elevated-lactate-levels-are-associated-with-microcirculatory-flow-abnormalities-and-increased-mortality-a-microsoap-post-hoc-analysis
#14
Namkje A R Vellinga, E Christiaan Boerma, Matty Koopmans, Abele Donati, Arnaldo Dubin, Nathan I Shapiro, Rupert M Pearse, Peter H J van der Voort, Arjen M Dondorp, Tony Bafi, Michael Fries, Tulin Akarsu-Ayazoglu, Andrius Pranskunas, Steven Hollenberg, Gianmarco Balestra, Mat van Iterson, Farid Sadaka, Gary Minto, Ulku Aypar, F Javier Hurtado, Giampaolo Martinelli, Didier Payen, Frank van Haren, Anthony Holley, Hernando Gomez, Ravindra L Mehta, Alejandro H Rodriguez, Carolina Ruiz, Héctor S Canales, Jacques Duranteau, Peter E Spronk, Shaman Jhanji, Sheena Hubble, Marialuisa Chierego, Christian Jung, Daniel Martin, Carlo Sorbara, Jan Bakker, Can Ince
BACKGROUND: Mildly elevated lactate levels (i.e., 1-2 mmol/L) are increasingly recognized as a prognostic finding in critically ill patients. One of several possible underlying mechanisms, microcirculatory dysfunction, can be assessed at the bedside using sublingual direct in vivo microscopy. We aimed to evaluate the association between relative hyperlactatemia, microcirculatory flow, and outcome. METHODS: This study was a predefined subanalysis of a multicenter international point prevalence study on microcirculatory flow abnormalities, the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP)...
October 18, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29026888/korean-shock-society-septic-shock-registry-a-preliminary-report
#15
Tae Gun Shin, Sung Yeon Hwang, Gu Hyun Kang, Won Young Kim, Seung Mok Ryoo, Kyuseok Kim, You Hwan Jo, Sung Phil Chung, Young Seon Joo, Jin Ho Beom, Sung-Hyuk Choi, Young Hoon Yoon, Woon Yong Kwon, Tae Ho Lim, Kap Su Han, Han Sung Choi, Gil Joon Suh
OBJECTIVE: To evaluate the clinical characteristics, therapeutic interventions, and outcomes of patients with septic shock admitted to the emergency department (ED). METHODS: This study was a preliminary, descriptive analysis of a prospective, multi-center, observational registry of the EDs of 10 hospitals participating in the Korean Shock Society. Patients aged 19 years or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion were included...
September 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/28926643/skin-perfusion-pressure-as-an-indicator-of-tissue-perfusion-in-valvular-heart-surgery-preliminary-results-from-a-prospective-observational-study
#16
Young Song, Sarah Soh, Jae-Kwang Shim, Kyoung-Un Park, Young-Lan Kwak
Hemodynamic management aims to provide adequate tissue perfusion, which is often altered during cardiac surgery with cardiopulmonary bypass (CPB). We evaluated whether skin perfusion pressure (SPP) can be used for monitoring of adequacy of tissue perfusion in patients undergoing valvular heart surgery. Seventy-two patients undergoing valve replacement were enrolled. SPP and serum lactate level were assessed after anaesthesia induction (baseline), during CPB, after CPB-off, end of surgery, arrival at intensive care unit, and postoperative 6 h...
2017: PloS One
https://www.readbyqxmd.com/read/28923305/risk-factors-for-mortality-in-patients-with-low-lactate-level-and-septic-shock
#17
Dong Hyun Oh, Moo Hyun Kim, Woo Yong Jeong, Yong Chan Kim, Eun Jin Kim, Je Eun Song, In Young Jung, Su Jin Jeong, Nam Su Ku, Jun Yong Choi, Young Goo Song, June Myung Kim
BACKGROUND: According to the new definition of septic shock, vasopressor therapy and hyperlactatemia are essential for diagnosis. However, there is controversy regarding the cutoff value for lactate, and prognostic factors in patients with septic shock and hypolactatemia. This study evaluated the prognostic significance of the cutoff value for lactate level in septic shock patients. METHODS: The retrospective observational cohort study enrolled 1043 patients aged ≥18 years who meet the revised definition of septic shock...
August 26, 2017: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
https://www.readbyqxmd.com/read/28915214/non-hemodynamic-effects-of-catecholamines
#18
Clair Hartmann, Peter Radermacher, Martin Wepler, Benedikt Nußbaum
Circulatory shock is defined as an imbalance between tissue oxygen supply and demand, and mostly results from a loss of blood volume, cardiac pump failure, and/or reduction of vasomotor tone. The clinical hallmarks of circulatory shock are arterial hypotension and lactate acidosis. Since the degree and duration of hypotension are major determinants of outcome, vasopressor administration represents a cornerstone therapy to treat these patients. Current guidelines recommend the use of catecholamines as the drug of first choice...
October 2017: Shock
https://www.readbyqxmd.com/read/28906389/risk-factor-analysis-for-nonocclusive-mesenteric-ischemia-following-cardiac-surgery-a-case-control-study
#19
Ju Yong Lim, Joon Bum Kim, Sung Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee
Although rare, postcardiac surgery nonocclusive mesenteric ischemia (NOMI) is a life-threatening condition. Identifying the risk factors for NOMI during immediate postoperative period may help early detection and intervention, which leads to improved clinical outcomes. The objective of this study was to identify the clinical features and risk factors of NOMI for prognosis identification after cardiac surgery, focusing on immediate postoperative parameters.Among 9445 patients who underwent cardiac surgery over a span of 9 years, 40 NOMI cases (0...
September 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28906282/dolutegravir-and-metformin-a-case-of-hyperlactatemia
#20
Mark Naccarato, Deborah Yoong, Ignatius W Fong
No abstract text is available yet for this article.
September 24, 2017: AIDS
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