Rosiglitazon ve metformin ile zehirlenme olgusunun başarılı tedavisi
Metformin yüksek dozlarda laktik asidoza sebep olabilen biguanid grubu bir antidiyabetiktir. Rosiglitazon tiazolidindion grubu insülin duyarlılığını artıran bir antidiyabetiktir. 35 yaşında, kadın hasta, 48 gr metformin, 108 mg roziglitazonu intihar amaçlı almış ve bilinç kaybı, oligüri, bulantı, kusma şikayetleri ile hastaneye başvurdu. Hipotansiyon, hipoglisemi ve metabolik asidoz gözlenen hastanın Glasgow koma skalası 5 olması nedeniyle mekanik ventilatöre bağlandı. Devamlı venövenöz hemodiyafiltrasyon ve destek tedavisi verilen, 39 gün mekanik ventilatörde takip edilen hasta yatışının 45.gününde şifa ile taburcu edildi. İntihar amacı ile aşırı doz ilaç alan yüksek anyon açıklı metabolik asidoz olan hastalarda metformin intoksikasyonundan şüphelenilmesi gerekir. Metformin ilişkili hipoglisemi, hipotermi ve laktik asidoz geri dönüşümlü olduklarından metabolik asidozun erken tanısı ve hemodiyaliz ve hemofiltrasyon ile birlikte kardiyovasküler destek, kan glukozunun ve vücut ısısının korunması hastanın düzelmesine olanak sağlar.
Successful treatment of intoxication case with rosiglitasone and metformin
Metformin is a biguanide antidiabetic high doses of which may cause lactic acidosis. Rosiglitazone is a member of thiazolidinedione antidiabetics group which increases insulin sensitivity. A 35-year-old female patient was admitted to hospital with the complaints of loss of consciousness, oliguria, nausea and vomiting after a history of 48 g of metformin, 108 mg rosiglitasone uptake for suicide. Hypotension, hypoglycemia and metabolic acidosis were observed in the patient, sos he was supported by mechanical ventilation due to the Glasgow coma scale 5. The patient was discharged home on the 45th day after continuous venovenous hemodiafiltration, supplamentary treatment and 39 days of mechanical ventilation support. There must be a suspicion for metformin intoxication in the patients with high anionic gap metabolic acidosis, and who take overdose drugs for suicide. Since metformin associated hypoglycemia, lactic acidosis and hypothermia are reversible, early diagnosis of metabolic acidosis and cardiovascular support with hemodialysis and hemofiltration protect blood glucose level and body temperature, which allow for possible recovery.
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- 1.Chang CT, Chen YC, Fang JT, Huang CC. Metformin-associated lactic acidosis: case reports and literature review. J Nephrol 2002; 15: 398-402.
- 2.Arıkan fi, Tuzcu A, Bahçeci M, Kaplan MA, Gökalp D. Massive Metformin Overdose in Two Subjects with Suicidal Behavior: Brief Communication. Turkiye Klinikleri J Med Sci 2012; 32: 559-562.
- 3.fiencan A, Adanır T, Atay A, Atasoy AA, Aksun M, Terzi G, Karahan N. Suisid Girişimi Sonrası Yüksek Anyon Açığı Olan Metabolik Asidoz: Metformin Entoksikasyonu. Anestezi Dergisi 2011; 19: 56-59.
- 4.Spiegelman BM. PPAR-g. Adipogenic regulator and thiazolidinedione receptor. Diabetes 1998; 47: 507-514.
- 5.Wolffenbuttel BH, Sels JP, Huijberts MS. Rosiglitazone. Expert Opin Pharmacother 2001; 2:467.
- 6.El-Naggar MH, Helmy A, Moawad M, Al-Omary M, Al-Kadhi Y, Habib. Late-onset rosiglitazone-associated acute liver failure in a patient with Hodgkin's lymphoma. Ann Pharmacother. 2008; 42: 713-718.
- 7. şoyd JS, Barbehenn E, Lurie P, Wolfe SM. Case series of liver failure associated with rosiglitazone and pioglitazone. Pharmacoepidemiol Drug Saf. 2009; 18: 1238-1243.
- 8. Gjedde S, Christiansen A, Pedersen SB, Rungby J. Survival following a metformin overdose of 63 g: a case report. Pharmacol Toxicol. 2003; 93: 98-99.
- 9. Suchard JR, Grotsky TA. Fatal metformin overdose presenting with progressive hyperglycemia. West J Emerg Med. 2008; 9: 160-164.
- 10. Choi HK, Tan GS, Sundar G. Rosiglitazone toxicity: accidental overdose leading to macular edema. Retinal Cases & Brief Reports: 2010; 4: 73-77.
- 11. Lacher M, Hermanns-Clausen M, Haeffner K, et al. Severe metformin intoxication with lactic acidosis in an adolescent. Eur J Pediatr 2005; 164: 362-365.
- 12. Zitzmann S, Reimann IR, Schmechel H. Severe hypoglycemia in an elderly patient treated with metformin. Int J Clin Pharmacol Ther 2002; 40: 108110.
- 13. Soderstrom J, Murray L, Daly FF, Little M. Toxicology case of the month: oral hypoglycaemic overdose. Emerg Med J 2006; 23: 565-567.
- 14. Gürlek ÖA. Yeni geliştirilen oral hipoglisemik ajanlar. Türkiye Tıp Dergisi 2001;8(Ek1): 45-49.
- 15. Marcy TR, Britton ML, Blevins SM. Second-generation thiazolidinediones and hepatotoxicity. Ann Pharmacother. 2004; 38: 1419-1423.
- 16. Isley WL. Hepatotoxicity of thiazolidinediones. Expert Opin Drug Saf. 2003; 2: 581-586.
- 17. Tulunay M, Yılmaz AA. Zehirlenmelerde ekstrakorporeal tedavi. Journal of the Turkish Society of Intensive Care 2009; 7: 42-62.
- 18. Lalau JD, Mourlhon C, Bergeret A, Lacroix C. Consequences of metformin intoxication. Diabetes Care 1998; 21: 2036-2037.
- 19. Perincek G, Edis EÇ, Güldiken S, Uyanık Mfi. Metformin intoksikasyonuna bağlı gelişen nadir bir tablo: ağır laktik asidoz ve ani kardiyak arrest. J Kartal TR 2009; 20: 42-44.
- 20. Barrueto F, Meggs WJ, Barchman MJ. Clearance of metformin by hemofiltration in overdose. J Toxicol Clin Toxicol 2002; 40: 177-180.