Osmolar-gap in the setting of metformin-associated lactic acidosis
<h3>Rationale</h3><p dir="ltr">Metformin-associated lactic acidosis (MALA) is a rare adverse effect that has significant morbidity and mortality. MALA is a high anion gap (AG), nonosmolar acidosis. Associated osmolar-gap (OG) is rarely reported, so finding an OG may make...
Saved in:
| Main Author: | |
|---|---|
| Other Authors: | , |
| Published: |
2020
|
| Subjects: | |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1864513553985175552 |
|---|---|
| author | Mohamed Nabil Elshafei (9960500) |
| author2 | Mohammed Alamin (20375244) Mouhand F.H. Mohamed (16932579) |
| author2_role | author author |
| author_facet | Mohamed Nabil Elshafei (9960500) Mohammed Alamin (20375244) Mouhand F.H. Mohamed (16932579) |
| author_role | author |
| dc.creator.none.fl_str_mv | Mohamed Nabil Elshafei (9960500) Mohammed Alamin (20375244) Mouhand F.H. Mohamed (16932579) |
| dc.date.none.fl_str_mv | 2020-10-09T03:00:00Z |
| dc.identifier.none.fl_str_mv | 10.1097/md.0000000000022492 |
| dc.relation.none.fl_str_mv | https://figshare.com/articles/journal_contribution/Osmolar-gap_in_the_setting_of_metformin-associated_lactic_acidosis/27951408 |
| dc.rights.none.fl_str_mv | CC BY 4.0 info:eu-repo/semantics/openAccess |
| dc.subject.none.fl_str_mv | Biomedical and clinical sciences Clinical sciences case report MALA metformin acidosis metformin toxicity osmolal gap osmolar gap |
| dc.title.none.fl_str_mv | Osmolar-gap in the setting of metformin-associated lactic acidosis |
| dc.type.none.fl_str_mv | Text Journal contribution info:eu-repo/semantics/publishedVersion text contribution to journal |
| description | <h3>Rationale</h3><p dir="ltr">Metformin-associated lactic acidosis (MALA) is a rare adverse effect that has significant morbidity and mortality. MALA is a high anion gap (AG), nonosmolar acidosis. Associated osmolar-gap (OG) is rarely reported, so finding an OG may make the diagnosis of MALA challenging.</p><h3>Patient concerns</h3><p dir="ltr">Forty-five years’ old type II diabetic patient on metformin presented to emergency with a two-day history of vomiting, watery diarrhea, and mild abdominal discomfort. On examinations, he looked dehydrated. Investigation revealed acute kidney injury (AKI) with a high lactic acid (LA) level of 24 mmol/L, pH of 6.8, AG of 40, and an OG of 20 mOsm/kg</p><h3>Diagnoses</h3><p dir="ltr">The presence of an OG made the diagnosis challenging; the history was negative for alcohol, osmolar substance, or illicit drug ingestion or use. The toxicology screen was negative. After ruling out plausible causes of AG and OG, MALA was deemed the likely reason for his presentation likely precipitated by dehydration and AKI.</p><h3>Interventions</h3><p dir="ltr">He underwent two sessions of hemodialysis, afterward managed with fluid hydration.</p><h3>Outcomes</h3><p dir="ltr">On day 3, he was in the polyuric phase suggestive of acute tubular necrosis. His serum creatinine improved afterward with improved acidosis; after 8 days, he was discharged in stable condition.</p><h3>Lessons</h3><p dir="ltr">MALA is a rare side effect of metformin therapy. Acute kidney injury is a known precipitant of MALA. In our review, we highlight the association of MALA and the presence of an OG. We believe that treating physicians should be aware of this relationship to avoid delaying or overlooking such an important diagnosis.</p><h2>Other Information</h2><p dir="ltr">Published in: Medicine<br>License: <a href="https://creativecommons.org/licenses/by/4.0/" rel="noreferrer" target="_blank">https://creativecommons.org/licenses/by/4.0/</a></p><p dir="ltr">See article on publisher's website: <a href="https://dx.doi.org/10.1097/md.0000000000022492" target="_blank">https://dx.doi.org/10.1097/md.0000000000022492</a></p> |
| eu_rights_str_mv | openAccess |
| id | Manara2_82c32fc29770455a12ad05c99a8d1336 |
| identifier_str_mv | 10.1097/md.0000000000022492 |
| network_acronym_str | Manara2 |
| network_name_str | Manara2 |
| oai_identifier_str | oai:figshare.com:article/27951408 |
| publishDate | 2020 |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| rights_invalid_str_mv | CC BY 4.0 |
| spelling | Osmolar-gap in the setting of metformin-associated lactic acidosisMohamed Nabil Elshafei (9960500)Mohammed Alamin (20375244)Mouhand F.H. Mohamed (16932579)Biomedical and clinical sciencesClinical sciencescase reportMALAmetformin acidosismetformin toxicityosmolal gaposmolar gap<h3>Rationale</h3><p dir="ltr">Metformin-associated lactic acidosis (MALA) is a rare adverse effect that has significant morbidity and mortality. MALA is a high anion gap (AG), nonosmolar acidosis. Associated osmolar-gap (OG) is rarely reported, so finding an OG may make the diagnosis of MALA challenging.</p><h3>Patient concerns</h3><p dir="ltr">Forty-five years’ old type II diabetic patient on metformin presented to emergency with a two-day history of vomiting, watery diarrhea, and mild abdominal discomfort. On examinations, he looked dehydrated. Investigation revealed acute kidney injury (AKI) with a high lactic acid (LA) level of 24 mmol/L, pH of 6.8, AG of 40, and an OG of 20 mOsm/kg</p><h3>Diagnoses</h3><p dir="ltr">The presence of an OG made the diagnosis challenging; the history was negative for alcohol, osmolar substance, or illicit drug ingestion or use. The toxicology screen was negative. After ruling out plausible causes of AG and OG, MALA was deemed the likely reason for his presentation likely precipitated by dehydration and AKI.</p><h3>Interventions</h3><p dir="ltr">He underwent two sessions of hemodialysis, afterward managed with fluid hydration.</p><h3>Outcomes</h3><p dir="ltr">On day 3, he was in the polyuric phase suggestive of acute tubular necrosis. His serum creatinine improved afterward with improved acidosis; after 8 days, he was discharged in stable condition.</p><h3>Lessons</h3><p dir="ltr">MALA is a rare side effect of metformin therapy. Acute kidney injury is a known precipitant of MALA. In our review, we highlight the association of MALA and the presence of an OG. We believe that treating physicians should be aware of this relationship to avoid delaying or overlooking such an important diagnosis.</p><h2>Other Information</h2><p dir="ltr">Published in: Medicine<br>License: <a href="https://creativecommons.org/licenses/by/4.0/" rel="noreferrer" target="_blank">https://creativecommons.org/licenses/by/4.0/</a></p><p dir="ltr">See article on publisher's website: <a href="https://dx.doi.org/10.1097/md.0000000000022492" target="_blank">https://dx.doi.org/10.1097/md.0000000000022492</a></p>2020-10-09T03:00:00ZTextJournal contributioninfo:eu-repo/semantics/publishedVersiontextcontribution to journal10.1097/md.0000000000022492https://figshare.com/articles/journal_contribution/Osmolar-gap_in_the_setting_of_metformin-associated_lactic_acidosis/27951408CC BY 4.0info:eu-repo/semantics/openAccessoai:figshare.com:article/279514082020-10-09T03:00:00Z |
| spellingShingle | Osmolar-gap in the setting of metformin-associated lactic acidosis Mohamed Nabil Elshafei (9960500) Biomedical and clinical sciences Clinical sciences case report MALA metformin acidosis metformin toxicity osmolal gap osmolar gap |
| status_str | publishedVersion |
| title | Osmolar-gap in the setting of metformin-associated lactic acidosis |
| title_full | Osmolar-gap in the setting of metformin-associated lactic acidosis |
| title_fullStr | Osmolar-gap in the setting of metformin-associated lactic acidosis |
| title_full_unstemmed | Osmolar-gap in the setting of metformin-associated lactic acidosis |
| title_short | Osmolar-gap in the setting of metformin-associated lactic acidosis |
| title_sort | Osmolar-gap in the setting of metformin-associated lactic acidosis |
| topic | Biomedical and clinical sciences Clinical sciences case report MALA metformin acidosis metformin toxicity osmolal gap osmolar gap |