Intrafacility Rescue?

[chbare]

It looks like somebody pretty much answered the scenario while I was typing my last post.

Several events led up to a possible disaster:

1) Upon the initial scan, the hospital staff missed the renal issues and metformin use.

2) After the first scan, the staff still did not identify the problem and the patient continued taking metformin.

3) The following day, the patient was scanned with IV contrast again and still continued on metformin.

4) The prior events were not identified upon the patient's second pesentation to the ER.

As is the case in the real world, a chain of several events let to this problem.

So, can anybody explain why (physiology) she developed the lactic acidosis?

Take care,

chbare.

[katbemeEMT-B]

Metformin is an oral antihyperglycemic agent

used to treat patients with type 2 diabetes mellitus.

It is excreted unchanged by the kidneys,

with approximately 90% of the absorbed drug

eliminated within the first 24 hours.

Furthermore, it increases the intestinal production

of lactic acid. Therefore, any factor

such as renal insufficiency that decreases metformin

excretion thus increases serum lactate

levels and increases the risk of lactic acidosis.

Contrast material is nephrotoxic and, in

patients with renal insufficiency, can lead to

metformin accumulation, resulting in lactic

acidosis. The risk of contrast-induced renal

toxicity can be decreased by hydration and by

limiting the amount of contrast used.

[Just Plain Ruff]

I believe I answered the question - I asked if they gave her any dye???? I didn't see any response unless chbare was replying to my post?

[chbare]

My response was directed at your question. It was one of the key parts of the puzzle. In fact, she ended up getting a whole lot of IV contrast.

Take care,

chbare.

[Just Plain Ruff]

that's just not a good thing. Who'd have thunk it.