Dr. Mohamed Shirazy
Department of Critical Care Medicine; King Hamad University Hospital in Kingdom of Bahrain
Biography
Mohamed Shirazy has completed his Master degree in Critical Care Medicine from Alexandria University. He then completed the Euorpean Diploma of Intensive Care Medicine (EDIC), and the Membership of the Royal Collage of Emergency Medicine (MRCEM). He is currently a Senior registrar of Critical Care Medicine in King Hamad University Hospital, Bahrain and Honorary lecturer in the Royal college of surgeons of Ireland (RCSI), Bahrain.
Abstract
Metformin-associated lactic acidosis (MALA) is the most serious and life-threatening adverse effect of Metformin. It’s presentations vary from nausea, vomiting, abdominal pain, and cardiac arrhythmias up to vasodilator shock which is characterized decreased systemic vascular resistance (SVR). Vasopressors as Nor-epinephrine and Epinephrine are used to treat the vasodilator shock via increasing the SVR. SVR is measured using the formula {80*(Mean Arterial Pressure-Central Venous Pressure)/Cardiac Output}. In clinical practice, Transthoracic echocardiography (TTE) is a non-invasive and accurate modality for measuring the cardiac output (CO). A 57-year-old male patient was admitted to the ICU with the diagnosis of vasodilator shock induced by MALA. He had history of heavy alcohol consumption, type II Diabetes Mellitus on metformin, and hypertension on amlodipine. Serial measurements of SVR were obtained aided by the TTE and vasopressors doses were titrated accordingly. High doses of Nor-epinephrine and Epinephrine up to 4 mcg/kg/min, and 4 mcg/min respectively were reached. In addition to the standard supportive medical treatment, ninety hours of continuous renal replacement therapy (CRRT) were provided to improve all of the lactic acidosis, renal impairment, and hyperkalemia. By the tenth day of the patient’s ICU stay both vasopressors were weaned off and the patient was discharged toward by the fifteenth day.