Metformin-induced lactic acidosis: a case series

<p>Abstract</p> <p>Introduction</p> <p>Unlike other agents used in the treatment of type 2 diabetes mellitus, metformin has been shown to reduce mortality in obese patients. It is therefore being increasingly used in higher doses. The major concern of many physicians is a possible risk of lactic acidosis. The reported frequency of metformin related lactic acidosis is 0.05 per 1000 patient-years; some authors advocate that this rate is equal in those patients not taking metformin.</p> <p>Case presentation</p> <p>We present two case reports of metformin-associated lactic acidosis. The first case is a 77 year old female with a past medical history of hypertension and type 2 diabetes mellitus who had recently been prescribed metformin (3 g/day), perindopril and acetylsalicylic acid. She was admitted to the emergency department two weeks later with abdominal pain and psychomotor agitation. Physical examination revealed only signs of poor perfusion. Laboratory evaluation revealed hyperkalemia, elevated creatinine and blood urea nitrogen and mild leukocytosis. Arterial blood gases showed severe lactic acidemia. She was admitted to the intensive care unit. Vasopressor and ventilatory support was initiated and continuous venovenous hemodiafiltration was instituted. Twenty-four hours later, full clinical recovery was observed, with return to a normal serum lactate level. The patient was discharged from the intensive care unit on the sixth day. The second patient is a 69 year old male with a past medical history of hypertension, type 2 diabetes mellitus and ischemic heart disease who was on metformin (4 g/day), glycazide, acetylsalicylic acid and isosorbide dinitrate. He was admitted to the emergency department in shock with extreme bradycardia. Initial evaluation revealed severe lactic acidosis and elevated creatinine and urea. The patient was admitted to the Intensive Care Unit and commenced on continuous venovenous hemodiafiltration in addition to other supportive measures. A progressive recovery was observed and he was discharged from the intensive care unit on the seventh day.</p> <p>Conclusion</p> <p>We present two case reports of severe lactic acidosis most probably associated with high doses of metformin in patients with no known contraindications for metformin prescription. In both patients no other condition was identified to cause such severe lactic acidosis. Although controversial, lactic acidosis should be considered in patients taking metformin.</p

Does high-dose metformin cause lactic acidosis in type 2 diabetic patients after CABG surgery? A double blind randomized clinical trial

Metformin is a dimethyl biguanide oral anti-hyperglycemic agent. Lactic acidosis due to metformin is a fatal metabolic condition that limits its use in patients in poor clinical condition, consequently reducing the number of patients who benefit from this medication. In a double blind randomized clinical trial, we investigated 200 type 2 diabetic patients after coronary artery bypass surgery in the open heart ICU of the Mazandaran Heart Center, and randomly assigned them to equal intervention and control groups. The intervention group received regular insulin infusion along with 2 metformin 500 mg tablets every twelve hours, while the control group received only intravenous insulin with 2 placebo tablets every twelve hours. Lactate level, pH, base excess, blood glucose and serum creatinine were measured over five 12 h periods, with data averaged for each period. The primary outcome in this study was high lactate levels. Comparison between the 2 groups was made by independent Student’s t-test. To compare changes in multiple measures in each group and analysis of group interaction, a repeated measurement ANOVA test was used

AN ANALYSIS OF LANGUAGE FUNCTIONS USED BY DONALD J. TRUMP IN HIS TWITTER TWEETS

Thesis ini mendiskusikan tentang fungsi-fungsi bahasa yang digunakan oleh Donald J. Trump di tweet twitternya. Dalam thesis ini, penulis mengemukakan dua pertanyaan yaitu : (1) Fungsi bahasa apa yang ditemukan di tweet twitternya Donald J. Trump? (2) Apa konteks pengunaan fungsi bahasa oleh Donald J. Trump di tweet twitternya?. Penelitian ini mencari tahu pengunaan fungsi bahasa dan konteks pengunaanya. Berdasarkan penjelasan di atas, penelitian ini berfokus pada pengunaan fungsi bahasa dan konteks pengunaanya di tweet twitter Donald J. Trump. Penulis mengaplikasikan teori fungsi bahasa oleh Jakobson tahun 1960 untuk melakukan penelitian. Penulis menggunakan pendekatan kualitatif karena pengumpulan data berbentuk kata atau teks. prosedur pengumpulan data berhubungan dengan pemilihan Donald J. Trump tweet di twitternya, mengidentifikasi kata, frase atau kalimat, lalau menganalisa setiap kata, frase dan kalimat yang mengandung fungsi bahasa berdasarkan teori Jakobson. Setelah menganalisa data, penulis menemukan lima jenis fungsi bahasa yakni referential fuction, conative function, emotive function, phatic function, and metalingual function. Referential Function paling sering digunakan oleh Donald J. Trump di tweetnya karena dia ingin membagi ide-ide, konsep, dan ambisi dia twitternya untuk membuat pengikutnya bergabung, percaya, dan memilih dia. Donald J. Trump mengunakan conative function dengan harapan bisa mengajak pengikutnya tetap terhubung dengannya. Kemudian emotive function digunakan untuk mengekspresikan kebahagian Donald J. Trump setelah kampanye dan mengunjungi beberapa tempat. Selanjutnya, phatic function digunakan untuk menyampaikan rasa solidaritas dia ke sahabatnya. Metalingual function digunakan untuk mengklarifikasi sebuah masalah yang ada

PENGELOLAAN MADU HUTAN BERBASIS KEARIFAN LOKAL MASYARAKAT DI DESA SEMALAH DAN DESA MELEMBA KAWASAN DANAU SENTARUM KABUPATEN KAPUAS HULU

Honey is one of the non-timber forest products (NTFPs). The management of forest honey can be done in a modern and traditional way. The purpose of this study to determine the processes of management of forest honey and the application of local wisdom values in the two villages and different farmer groups. The method used in this study is a survey by interview and questionnaire tools. Analysis of the data used is descriptive qualitative. Management of forest honey maintain sustainable forests as the availability of honey nest and bees feed. The local wisdom is still maintained that the use of honey nest derived from ancestral heritage in the form of tikung, repak and lalau. Keyword: Danau Sentarum Region, Honey Forest, NTFPs, Traditional Wisdo

SEJARAH PERKEMBANGAN TAFSIR

AbstrakKegiatan tafsir Al-Qu’ran telah dimulai sejak masa Nabi Muhammad Saw dan terus mengalami perkembangan dari masa ke masa, yaitu periode Nabi Muhammad Saw dan sahabatnya, periode tabi’in, dan periode modern. Dengan kembali mencermati sejarah perkembangan tafsir yang telah disinggung, maka tentu saja di setiap periode dan masa perkembangannya memiliki keunikan tersendiri. Penelitian ini bertujuan untuk mengetahui sejarah perkembangan tafsir berdasarkan tiga periode yang telah disebutkan. Metode penelitian yang digunakan adalah library research (penelitian pustaka) dengan mengumpulkan informasi-informasi yang dibutuhkan pada berbagai sumber referensi seperti buku, catatan, ataupun artikel penelitian. Hasil penelitian ini mengungkapkan bahwa pada masa Nabi Muhammad Saw, kegiatan tafsir Al-Qur’an terus mengalami perkembangan hingga melahirkan aliran-aliran dan metode tafsir yang sangat beragam. Pada masa sahabat, Al-Qur’an ditafsirkan dengan metode riwayah atau terkadang ijtihad apabila sebuah ayat tidak ditafsirkan oleh Nabi Muhammad Saw. Pada masa tabi’in perkembangan tafsir ditandai dengan munculnya aliran-aliran tafsir di Mekah, Madinah, dan Irak. Perkembangan tafsir terus berlanjut hingga munculnya kitab-kitab tafsir yang terjadi pada periode tadwiin atau periode kodifikasi tafsir. Setelah masa ini, penafsiran Al-Qur’an memasuki periode modern yang ditandai dengan munculnya metode baru dalam menafsirkan Al-Qur’an, yakni metode maudhui. AbstractThe activity of tafsir Qur'an has been started since the time of the Prophet Muhammad. and continues to develop from time to time, namely the period of the Prophet Muhammad. and his companions, the tabi'in period, and the modern period. By looking back at the history of the development of tafsir that has been alluded to, then of course each period and period of its development has its own uniqueness. This study aims to determine the history of the development of tafsir based on the three periods mentioned. The research method used is library research by collecting the required information from various reference sources such as books, notes, or research articles. The results of this study reveal that at the time of the Prophet Muhammad, the activity of tafsir the Qur'an continues to develop until it gives birth to various schools and methods of tafsir. At the time of the Companions, the Qur'an was interpreted using the riwayah method or sometimes ijtihad if a verse was not interpreted by the Prophet Muhammad. During the tabi'in period, the development of tafsir was marked by the emergence of schools of tafsir in Mecca, Medina, and Iraq. The development of commentary continues until the emergence of books of tafsir that occur in the tadwiin period or the period of codification of tafsir. After this period, the tafsir of the Qur'an entered the modern period which was marked by the emergence of a new method of interpreting the Qur'an, namely the maudhui method