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https://www.readbyqxmd.com/read/28202871/the-dramatic-recovery-of-a-patient-with-biguanide-associated-severe-lactic-acidosis-following-thiamine-supplementation
#1
Shigeo Godo, Yoshitaro Yoshida, Motoo Fujita, Daisuke Kudo, Ryosuke Nomura, Hiroaki Shimokawa, Shigeki Kushimoto
Biguanides are a drug of choice for the treatment of type 2 diabetes mellitus. Although they can cause lactic acidosis in susceptible patients with predisposing risk factors, the incidence of lactic acidosis is reported to be very low when they are used properly. We herein present a case of biguanide-associated severe lactic acidosis complicated with thiamine deficiency that was provoked without predisposing factors for thiamine deficiency. Diabetic patients taking biguanide may be predisposed to thiamine deficiency, even when there is no evidence of risk factors, and the high-dose administration of thiamine may be essential in the treatment of this otherwise under-recognized disorder...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28202819/-melas-mitochondrial-encephalomyopathy-lactic-acidosis-and-stroke-like-episodes
#2
Hidetomo Murakami, Kenjiro Ono
Mitochondrial disease is caused by a deficiency in the energy supply to cells due to mitochondrial dysfunction. Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) is a mitochondrial disease that presents with stroke-like episodes such as acute onset of neurological deficits and characteristic imaging findings. Stroke-like episodes in MELAS have the following features: 1) neurological deficits due to localization of lesions in the brain, 2) episodes often accompany epilepsy, 3) lesions do not follow the vascular supply area, 4) lesions are more often seen in the posterior brain than in the anterior brain, 5) lesions spread to an adjacent area in the brain, and 6) neurological symptoms often disappear together with imaging findings, but later relapse...
February 2017: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/28202214/lethal-neonatal-case-and-review-of-primary-short-chain-enoyl-coa-hydratase-sceh-deficiency-associated-with-secondary-lymphocyte-pyruvate-dehydrogenase-complex-pdc-deficiency
#3
Jirair K Bedoyan, Samuel P Yang, Sacha Ferdinandusse, Rhona M Jack, Alexander Miron, George Grahame, Suzanne D DeBrosse, Charles L Hoppel, Douglas S Kerr, Ronald J A Wanders
Mutations in ECHS1 result in short-chain enoyl-CoA hydratase (SCEH) deficiency which mainly affects the catabolism of various amino acids, particularly valine. We describe a case compound heterozygous for ECHS1 mutations c.836T>C (novel) and c.8C>A identified by whole exome sequencing of proband and parents. SCEH deficiency was confirmed with very low SCEH activity in fibroblasts and nearly absent immunoreactivity of SCEH. The patient had a severe neonatal course with elevated blood and cerebrospinal fluid lactate and pyruvate concentrations, high plasma alanine and slightly low plasma cystine...
February 2, 2017: Molecular Genetics and Metabolism
https://www.readbyqxmd.com/read/28196511/antiretroviral-therapy-related-adverse-effects-can-sub-saharan-africa-cope-with-the-new-test-and-treat-policy-of-the-world-health-organization
#4
Jobert Richie N Nansseu, Jean Joel R Bigna
BACKGROUND: Recent studies have shown that early antiretroviral therapy (ART) initiation results in significant HIV transmission reduction. This is the rationale behind the "test and treat" policy of the World Health Organization (WHO). Implementation of this policy will lead to an increased incidence of ART-related adverse effects, especially in sub-Saharan Africa (SSA). Is the region yet ready to cope with such a challenging issue? MAIN BODY: The introduction and widespread use of ART have drastically changed the natural history of HIV/AIDS, but exposure to ART leads to serious medication-related adverse effects mainly explained by mitochondrial toxicities, and the situation will get worse in the near future...
February 15, 2017: Infectious Diseases of Poverty
https://www.readbyqxmd.com/read/28188168/metformin-associated-lactic-acidosis-treated-with-continuous-renal-replacement-therapy
#5
Akihide Nakamura, Kei Suzuki, Hiroshi Imai, Naoyuki Katayama
Metformin-associated lactic acidosis (MALA) is a rare but life-threatening complication. We report a case of MALA in a man aged 71 years who was treated with continuous renal replacement therapy (CRRT). The patient was brought to the hospital for prolonged and gradual worsening gastrointestinal symptoms. Although he received intravenous treatment, he developed catecholamine-resistant shock, and blood gas analysis revealed lactic acidosis. Bicarbonate and antibiotics for possible sepsis were initiated, but with no clear benefit...
February 10, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28186714/lactic-acidosis-with-chloramphenicol-treatment-in-a-child-with-cystic-fibrosis
#6
Isabelle Goyer, Massimiliano Iseppon, Céline Thibault, Rachid Abaji, Maja Krajinovic, Julie Autmizguine
Children with cystic fibrosis are commonly colonized with multi-resistant bacteria. In such patients, infectious exacerbation may require salvage therapy with uncommonly used antimicrobials, including chloramphenicol. Chloramphenicol is rarely used nowadays because of the associated severe adverse events. We describe the case of a 15-year-old female with terminal cystic fibrosis who required intravenous (IV) chloramphenicol treatment for a Burkholderia cepacia (B. cepacia) exacerbation. The child subsequently developed lactic acidosis and secondary respiratory compensation adding to her baseline respiratory distress...
January 30, 2017: Journal of Population Therapeutics and Clinical Pharmacology
https://www.readbyqxmd.com/read/28183503/a-66-year-old-woman-with-sudden-onset-of-disseminated-intravascular-coagulation-lactic-acidosis-and-hypoglycemia
#7
Benjamin Henkle, Patrick Arndt
A 66-year-old woman presented to an urgent care clinic for 2 to 3 weeks of general malaise, nausea/vomiting, night sweats, and dyspnea. On examination, she was tachycardic, and her laboratory evaluation was normal except for a lactate level of 4.4 mmol/L and platelet count of 118 × 10(9)/L. CT imaging was performed. Two days later in the follow-up clinic, the patient's international normalized ratio (INR) was elevated, and she was hospitalized with initial findings of disseminated intravascular coagulation (DIC) (ie, INR > 10, platelets 97 × 10(9)/L, fibrinogen < 60 mg/dL, positive D-dimer result)...
February 2017: Chest
https://www.readbyqxmd.com/read/28163135/a-mechanism-based-pharmacokinetic-enzyme-turnover-model-for-dichloroacetic-acid-auto-inhibition-in-rats
#8
Yu Jiang, Gary Milavetz, Margaret O James, Guohua An
Dichloroacetic acid (DCA), a halogenated organic acid, is a pyruvate dehydrogenase kinase (PDK) inhibitor that has been used to treat congenital or acquired lactic acidosis and is currently in early phase clinical trials for cancer treatment. DCA was found to inhibit its own metabolism by irreversibly inactivating glutathione transferase zeta 1 (GSTZ1-1), resulting in non-linear kinetics and abnormally high accumulation ratio after repeated dosing. In this analysis, a semi-mechanistic pharmacokinetic-enzyme turn over model was developed for the first time to capture DCA auto-inhibition, gastrointestinal region-dependent absorption, and time dependent change in bioavailability in rats...
February 2, 2017: Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/28157807/factors-associated-with-mortality-in-continuous-renal-replacement-therapy-for-pediatric-patients-with-acute-kidney-injury
#9
Seung Jun Choi, Eun-Ju Ha, Won Kyoung Jhang, Seong Jong Park
OBJECTIVES: To analyze the epidemiology of pediatric acute kidney injury requiring continuous renal replacement therapy and identify prognostic factors affecting mortality rates. DESIGN: Retrospective analysis. SETTING: PICU of a tertiary medical center. PATIENTS: One hundred-twenty three children diagnosed with acute kidney injury requiring continuous renal replacement therapy. INTERVENTIONS: None...
February 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28155230/further-delineation-of-a-rare-recessive-encephalomyopathy-linked-to-mutations-in-gfer-thanks-to-data-sharing-of-whole-exome-sequencing-data
#10
S Nambot, D Gavrilov, J Thevenon, A L Bruel, M Bainbridge, M Rio, C Goizet, A Rötig, J Jaeken, N Niu, F Xia, A Vital, N Houcinat, F Mochel, P Kuentz, D Lehalle, Y Duffourd, J B Rivière, C Thauvin-Robinet, A L Beaudet, L Faivre
Alterations in GFER gene have been associated with progressive mitochondrial myopathy, congenital cataracts, hearing loss, developmental delay, lactic acidosis and respiratory chain deficiency in 3 siblings born to consanguineous Moroccan parents by homozygosity mapping and candidate gene approach (OMIM#613076). Next generation sequencing recently confirmed this association by the finding of compound heterozygous variants in 19-year-old girl with a strikingly similar phenotype, but this ultra-rare entity remains however unknown from most of the scientific community...
February 2, 2017: Clinical Genetics
https://www.readbyqxmd.com/read/28152176/metformin-sglt2-dehydration-and-acidosis-potential
#11
John A D'Elia, Alissa R Segal, Larry A Weinrauch
Clinicians are aware of the risks and benefits of metformin in type 2 diabetes. In geriatric populations lactic acidosis due to diminishing kidney function is an issue. The recent addition of a group of agents to control diabetes through increased glycosuria may increase the risk of dehydration and acidosis. This may happen due to gastrointestinal loss from metformin diarrhea or urine loss from diuretics. A typical example is presented.
February 2, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28149827/a-case-of-rapid-progression-of-postoperative-hyperthermia-dantrolene-or-not-dilemma
#12
Marzieh R Honardar, Jesus Rubio, Sanjay M Bhananker
Malignant hyperthermia (MH) is an extremely rare and life-threatening differential diagnosis of postoperative fever. We present an 8-month-old child scheduled for elective outpatient procedure who rapidly developed high fever, tachycardia, and respiratory acidosis shortly after transfer to the postanesthesia care unit. MH hotline expert recommended administering dantrolene, but there was no evidence of hypermetabolism or lactic acidosis. The patient remained clinically stable after admission to the pediatric intensive care unit and was discharged home the next day...
October 2016: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28149822/a-profile-of-metabolic-acidosis-in-patients-with-sepsis-in-an-intensive-care-unit-setting
#13
Kartik Ganesh, R N Sharma, Jaicob Varghese, M G K Pillai
CONTEXT: Metabolic acidosis is frequently found in patients with severe sepsis. An understanding of types of acidosis in sepsis and their evolution over the course of treatment may give us insight into the behavior of acid-base balance in these patients. AIMS: To describe at Intensive Care Unit (ICU) admission and over the first 5 days the composition of metabolic acidosis in patients with sepsis and to evaluate and compare acidosis patterns in survivors and nonsurvivors...
October 2016: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28149346/differences-in-physiological-responses-to-interval-training-in-cyclists-with-and-without-interval-training-experience
#14
Rafal Hebisz, Paulina Hebisz, Jacek Borkowski, Marek Zatoń
The aim of this study was to determine differences in glycolytic metabolite concentrations and work output in response to an all-out interval training session in 23 cyclists with at least 2 years of interval training experience (E) and those inexperienced (IE) in this form of training. The intervention involved subsequent sets of maximal intensity exercise on a cycle ergometer. Each set comprised four 30 s repetitions interspersed with 90 s recovery periods; sets were repeated when blood pH returned to 7.3...
April 1, 2016: Journal of Human Kinetics
https://www.readbyqxmd.com/read/28147428/-lactic-acidosis-due-to-metformin-accumulation-complicating-acute-gastroenteritis
#15
Olga DŽupová, Jana Kulichová
Lactic acidosis is the most severe adverse effect associated with metformin therapy of type 2 diabetes mellitus. The risk increases in patients with impaired renal function, most commonly due to diabetic nephropathy, and may be augmented when concurrent medication with a negative impact on renal function is used. The authors present a series of three patients who were admitted to a department of infectious diseases for acute gastroenteritis and within a few hours developed shock syndrome caused by severe lactic acidosis due to accumulation of metformin...
December 2016: Klinická Mikrobiologie a Infekc̆ní Lékar̆ství
https://www.readbyqxmd.com/read/28141608/metformin-associated-lactic-acidosis-an-atypical-presentation
#16
Martin R Hevesy
Many Type 2 diabetic patients take metformin for its safety profile and lack of hypoglycemia. Although this drug is safe in those without renal dysfunction, lactic acidosis may rarely occur. Metformin-associated lactic acidosis is a potentially fatal yet rare diagnosis. Prompt recognition of even subtle symptoms can reduce mortality and preserve homeostasis.
January 2017: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/28139706/identification-of-mirna-lncrna-and-mrna-associated-cerna-networks-and-potential-biomarker-for-melas-with-mitochondrial-dna-a3243g-mutation
#17
Wei Wang, Qianqian Zhuang, Kunqian Ji, Bing Wen, Pengfei Lin, Yuying Zhao, Wei Li, Chuanzhu Yan
Researchers in the field of mitochondrial biology are increasingly unveiling of the complex mechanisms between mitochondrial dysfunction and noncoding RNAs (ncRNAs). However, roles of ncRNAs underlying mitochondrial myopathy remain unexplored. The aim of this study was to elucidate the regulating networks of dysregulated ncRNAs in Mitochondrial myopathy, Encephalopathy, Lactic Acidosis, and Stroke-like episodes (MELAS) with mitochondrial DNA (mtDNA) A3243G mutation, which might make contributions to the unveiling of the complex mechanisms underlying mitochondrial myopathy and, possibly, new tools applicable to clinical practice...
January 31, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28137904/bilateral-thigh-methicillin-resistant-staphylococcus-aureus-necrotising-fasciitis-in-a-man-with-newly-diagnosed-human-immunodeficiency-virus-hiv
#18
Dhruv Chaudhary, Amith Subhash, Juan Galvis, Juan Guardiola
Methicillin-resistant Staphylococcus aureus (MRSA) necrotising fasciitis (NF) is rare and constitutes a medical and surgical emergency. We report a case of a 53-year-old man with type-2 diabetes mellitus and newly diagnosed HIV infection who presented with 1 week of progressively worsening bilateral sharp thigh pain. On presentation, he was febrile, tachycardic and had bilateral thigh erythema and mild tenderness without open wounds. He had leucocytosis, lactic acidosis and acute kidney injury. Urgent incision and drainage (I&D) was performed for suspected NF...
January 30, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28134407/-metformin-associated-lactic-acidosis-and-acute-kidney-injury
#19
Paolo Greco, Giuseppe Regolisti, Riccardo Antoniotti, Caterina Maccari, Elisabetta Parenti, Silvia Corrado, Enrico Fiaccadori
Metformin is recommended as the treatment of choice in patients with type 2 diabetes mellitus because of its efficacy, general tolerability and low cost. Recent guidelines have extended the use of metformin to patients with Chronic Kidney Disease (CKD) up to stage III. However, in the recent literature, cases of MALA (metformin-associated lactic acidosis) are increasingly reported. MALA is the most dangerous side effect of the drug, with an incidence rate of 2-9 cases per 100000 person-years of exposure. We report on two patients with accidental metformin overdose, severe lactic acidosis and acute kidney injury...
November 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/28134396/-metabolic-acidosis
#20
Giuseppe Regolisti, Filippo Fani, Riccardo Antoniotti, Giuseppe Castellano, Elena Cremaschi, Paolo Greco, Elisabetta Parenti, Santo Morabito, Alice Sabatino, Enrico Fiaccadori
Metabolic acidosis is frequently observed in clinical practice, especially among critically ill patients and/or in the course of renal failure. Complex mechanisms are involved, in most cases identifiable by medical history, pathophysiology-based diagnostic reasoning and measure of some key acid-base parameters that are easily available or calculable. On this basis the bedside differential diagnosis of metabolic acidosis should be started from the identification of the two main subtypes of metabolic acidosis: the high anion gap metabolic acidosis and the normal anion gap (or hyperchloremic) metabolic acidosis...
November 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
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