ERDoc Posted July 13, 2007 Share Posted July 13, 2007 Is it possible that she has developed lactic acidosis as a result of taking the Metformin. This would be common in some one who has kidney disease? She may also be septic. Hmm...Interesting thought. What could possibly lead to metformin causing lactic acidosis? Chbare, I think my wife might object also. Sorry. Link to comment Share on other sites More sharing options...
katbemeEMT-B Posted July 13, 2007 Share Posted July 13, 2007 Hmm...Interesting thought. What could possibly lead to metformin causing lactic acidosis? Chbare, I think my wife might object also. Sorry. Found on the web researching. Copied exactly what it stated: Metformin can rarely cause a serious (sometimes fatal) condition called lactic acidosis. Stop taking metformin and seek immediate medical attention if you develop any of the following symptoms of lactic acidosis: unusual tiredness, severe drowsiness, chills, blue/cold skin, muscle pain, fast/difficult breathing, unusually slow/irregular heartbeat. Lactic acidosis is more likely to occur in patients who have certain medical conditions, including kidney or liver disease, conditions that may cause a low oxygen blood level or poor circulation (e.g., severe congestive heart failure, recent heart attack, recent stroke), heavy alcohol use, a severe loss of body fluids (dehydration), X-ray or scanning procedures that require an injectable iodinated contrast drug, recent surgery, or a serious infection. Tell your doctor immediately if any of these conditions occur or if you notice a big change in your overall health. You may need to stop taking metformin temporarily. The elderly are also at higher risk, especially those older than 80 years who have not had kidney tests. (See also Side Effects and Precautions sections.) I did add that I think it could also be complicated by the set in of sepsis. This could also explain a lot of her symptoms. Just taking a stab in the dark. Actually, the sepsis thing was as a result of my grandmother's illness. It started as a simple broken arm when she started to display many of the same symptoms mentioned in this scenario(AMS, lethargic, renal failure, etc). She was then diagnosed with sepsis and hospitalized again (she never ran a high temp). The sepsis eventually caused CHF and a resulting MI as she wasn't given her diuretic. She didn't survive. I used her illness as a learning experience to help some one elses grandmother. Thankfully, I was not working either times she was transported by the service I work for. So, I don't know that this is the case here, just trying to throw some things out there that fit the bill. Trying to improve my critical thinking skills. Link to comment Share on other sites More sharing options...
chbare Posted July 13, 2007 Author Share Posted July 13, 2007 We are very close to the answer. I agree that it is not common for people to simply develop lactic acidosis from metformin therapy. However, the patient was taking metformin and had known renal compromise. Then, something happened during her stay at the hospital that derailed the train so to speak. It not only happened once, but twice. This is something that should have never happened. What threw her kidneys over the edge? Carefully read the prior posts. Just as in real life, attention to detail can save the day. ERDoc, it was worth a try. Take care, chbare. Link to comment Share on other sites More sharing options...
Dustdevil Posted July 13, 2007 Share Posted July 13, 2007 ...the patient was taking metformin and had known renal compromise. Then, something happened during her stay at the hospital that derailed the train so to speak. It not only happened once, but twice. This is something that should have never happened. Levaquin. Link to comment Share on other sites More sharing options...
katbemeEMT-B Posted July 13, 2007 Share Posted July 13, 2007 The Metformin should have been discontinued before she was given the multiple CT Scans. This along with the "gut infection" and renal disease could have brought on her current symptoms. I am still leaning towards lactic acidosis as a result of renal disease, infection, and improper prescanning treament. Link to comment Share on other sites More sharing options...
Dustdevil Posted July 13, 2007 Share Posted July 13, 2007 ...the patient was taking metformin and had known renal compromise. Then, something happened during her stay at the hospital that derailed the train so to speak. It not only happened once, but twice. This is something that should have never happened. What threw her kidneys over the edge? Carefully read the prior posts. Just as in real life, attention to detail can save the day. Link to comment Share on other sites More sharing options...
ERDoc Posted July 13, 2007 Share Posted July 13, 2007 The Metformin should have been discontinued before she was given the multiple CT Scans. This along with the "gut infection" and renal disease could have brought on her current symptoms. I am still leaning towards lactic acidosis as a result of renal disease, infection, and improper prescanning treament. How does getting a CT scan cause lactic acidosis? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted July 13, 2007 Share Posted July 13, 2007 they didn't look at her bun and creatinine when the gave her the scans. Did they give her any dye? Link to comment Share on other sites More sharing options...
chbare Posted July 13, 2007 Author Share Posted July 13, 2007 So close I should not say a thing. Simply having a CT scan while taking metformin will not cause lactic acidosis. However, sometimes we do something to help with the view during a CT scan. Say this was done when we CT'd the the chest, then the abd, then the pelvis. Then, we did it all over again the next day. Add in the fact that we are on metformin and continued taking metformin in addition to pre-existing renal issues. This can add up to disaster. I know it is a long shot, but it can happen at Oz General Hospital. What was done durng the CT and how do we explain the pathophysiology of this situation? Take care, chbare. Link to comment Share on other sites More sharing options...
Dustdevil Posted July 13, 2007 Share Posted July 13, 2007 ...sometimes we do something to help with the view during a CT scan. Ah! Now it seems so clear, I don't know how I missed it before! They turned up the lights really bright, which caused her to start photosynthesizing. That threw off her whole Krebs cycle, resulting in hyperglycaemia and lactic acidosis, which threw her over the edge into renal failure. Link to comment Share on other sites More sharing options...
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