Yıl: 2020 Cilt: 14 Sayı: 3 Sayfa Aralığı: 231 - 235 Metin Dili: İngilizce DOI: 10.12956/tchd.723600 İndeks Tarihi: 27-07-2021

Metformin Intoxications Requiring Admission to the Pediatric Intensive Care Unit

Öz:
Objective: To identify the demographics of patients admitted with metformin intoxication and characterize their clinicalcourses and treatment options in pediatric intensive care unit.Material and Methods: The records of patients admitted to the pediatric intensive care unit due to metforminintoxication between 2013 and 2019 were retrospectively evaluated.Results: There were 22 acute metformin intoxication cases. Mean age of the patients was 13.04±5.46 years (1-18years), 18 were female. Ingested metformin dose ranged from 1.7 gr to 85 gr (mean 19±22.6 gr, median 10 gr), withcoingestants taken in 12 patients. Nausea and/or vomiting were present in 16 (72.7%) of the patients. Hyperlactatemia(lactate > 2mmol/L) was present in 13 (59%) of the patients. Mean peak lactate level was 5.1±5.7 mmol/L (0.9-21mmol/L). Acidosis was present in 12 (54.5%) of the patients. Mean lowest pH level was 7.28±0.16 (6.9-7.45). There wasa positive correlation between lactate level and ingested dose (r = 0.816; p < 0.001) while pH was inversely related todose (r = −0.873; p < 0.001). Six (27%) patients required renal replacement therapy because of profound lactic acidosisdespite the intravenous fluid support. Hemodialysis was applied to 5 patients and high dose continuous venovenoushemodiafiltration was applied to 2 patients. 16 years old female patient who ingested 85 g metformin died despiteprolonged hemodialysis.Conclusion: Lactic acidosis associated with metformin intoxication is a potentially fatal condition. Both renal replacementtherapies hemodialysis and continuous venovenous hemodiafiltration are effective in the treatment of metformin associatedlactic acidosis. Most of the patients with severe metformin associated lactic acidosis require repetitive and prolongedhemodialysis sessions.
Anahtar Kelime:

Çocuk Yoğun Bakım Yatışı Gerektiren Metformin Zehirlenmeleri

Öz:
Amaç: Metformin zehirlenmesi ile çocuk yoğun bakım ünitesine yatan hastaların demografik ve klinik özelliklerini ve tedavi seçeneklerini karakterize etmek. Gereç ve Yöntemler: 2013-2019 yılları arasında metformin zehirlenmesi nedeniyle çocuk yoğun bakım ünitesine başvuran hastaların kayıtları retrospektif olarak incelendi. Bulgular: Yirmi iki akut metformin doz aşımı çalışmaya dâhil edildi. Hastaların yaş ortalaması 13.04±5.46 yıl (1-18 yaş)’dı ve hastaların 18’i kızdı. Alınan metformin dozu, 1.7 gr ila 85 gr (ortalama 19±22.6 gr, medyan 10 gr) arasında değişmekteydi ve 12 hastada birlikte alınan başka ilaçlar mevcuttu. Hastaların 16’sında (%72.7) bulantı ve / veya kusma vardı. Hastaların 13’ünde (%59) hiperlaktatemi (laktat> 2 mmol / L) vardı. Ortalama pik laktat seviyesi 5.1±5.7 mmol / L (0.9-21 mmol / L)’di. Hastaların 12’sinde (% 54.5) asidoz mevcuttu. Ortalama en düşük pH seviyesi 7.28 ±0.16 (6.9-7.45)’di. Laktat seviyesi ile alınan doz arasında pozitif bir korelasyon var iken (r=0.816; p<0.001), pH ile alınan doz arasında negatif korelasyon mevcuttu. (r=−0.873; p <0.001). Altı (% 27) hastada intravenöz sıvı desteğine rağmen derin laktik asidoz nedeniyle renal replasman tedavisi gerekti. 5 hastaya hemodiyaliz, 2 hastaya yüksek dozda sürekli venövenöz hemodiafiltrasyon uygulandı. 85 g metformin alan 16 yaşında kız hasta uzun süreli hemodiyalize rağmen kaybedildi. Sonuç: Metformin zehirlenmesi ile ilişkili laktik asidoz potansiyel olarak ölümcül bir durumdur. Renal replasman tedavilerinden hem hemodiyaliz hem de sürekli venöz hemodiafiltrasyon, metformin ilişkili laktik asidozun tedavisinde etkilidir. Metformin ilişkili ciddi laktik asidozu olan hastaların çoğu tekrarlayan ve uzun süreli hemodiyaliz seansları gerektirebilir.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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APA Kesici S, BAYRAKCI B (2020). Metformin Intoxications Requiring Admission to the Pediatric Intensive Care Unit. , 231 - 235. 10.12956/tchd.723600
Chicago Kesici Selman,BAYRAKCI BENAN Metformin Intoxications Requiring Admission to the Pediatric Intensive Care Unit. (2020): 231 - 235. 10.12956/tchd.723600
MLA Kesici Selman,BAYRAKCI BENAN Metformin Intoxications Requiring Admission to the Pediatric Intensive Care Unit. , 2020, ss.231 - 235. 10.12956/tchd.723600
AMA Kesici S,BAYRAKCI B Metformin Intoxications Requiring Admission to the Pediatric Intensive Care Unit. . 2020; 231 - 235. 10.12956/tchd.723600
Vancouver Kesici S,BAYRAKCI B Metformin Intoxications Requiring Admission to the Pediatric Intensive Care Unit. . 2020; 231 - 235. 10.12956/tchd.723600
IEEE Kesici S,BAYRAKCI B "Metformin Intoxications Requiring Admission to the Pediatric Intensive Care Unit." , ss.231 - 235, 2020. 10.12956/tchd.723600
ISNAD Kesici, Selman - BAYRAKCI, BENAN. "Metformin Intoxications Requiring Admission to the Pediatric Intensive Care Unit". (2020), 231-235. https://doi.org/10.12956/tchd.723600
APA Kesici S, BAYRAKCI B (2020). Metformin Intoxications Requiring Admission to the Pediatric Intensive Care Unit. Türkiye Çocuk Hastalıkları Dergisi, 14(3), 231 - 235. 10.12956/tchd.723600
Chicago Kesici Selman,BAYRAKCI BENAN Metformin Intoxications Requiring Admission to the Pediatric Intensive Care Unit. Türkiye Çocuk Hastalıkları Dergisi 14, no.3 (2020): 231 - 235. 10.12956/tchd.723600
MLA Kesici Selman,BAYRAKCI BENAN Metformin Intoxications Requiring Admission to the Pediatric Intensive Care Unit. Türkiye Çocuk Hastalıkları Dergisi, vol.14, no.3, 2020, ss.231 - 235. 10.12956/tchd.723600
AMA Kesici S,BAYRAKCI B Metformin Intoxications Requiring Admission to the Pediatric Intensive Care Unit. Türkiye Çocuk Hastalıkları Dergisi. 2020; 14(3): 231 - 235. 10.12956/tchd.723600
Vancouver Kesici S,BAYRAKCI B Metformin Intoxications Requiring Admission to the Pediatric Intensive Care Unit. Türkiye Çocuk Hastalıkları Dergisi. 2020; 14(3): 231 - 235. 10.12956/tchd.723600
IEEE Kesici S,BAYRAKCI B "Metformin Intoxications Requiring Admission to the Pediatric Intensive Care Unit." Türkiye Çocuk Hastalıkları Dergisi, 14, ss.231 - 235, 2020. 10.12956/tchd.723600
ISNAD Kesici, Selman - BAYRAKCI, BENAN. "Metformin Intoxications Requiring Admission to the Pediatric Intensive Care Unit". Türkiye Çocuk Hastalıkları Dergisi 14/3 (2020), 231-235. https://doi.org/10.12956/tchd.723600