Naslov
Metabolička acidoza: očekivan i fatalan neželjeni učinak metformina i empagliflozina: prikaz slučajeva i pregled literature
(Metabolic acidosis: expected and fatal adverse effects of metformin and empagliflozin: a case series and literature review)

Autori
Degoricija, Vesna

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, pp prezentacija, stručni

Izvornik
Tečaj trajne medicinske izobrazbe 6. E kongres: Prikazi slučajeva iz kliničke prakse u endokrinologiji i dijabetologiji / - , 2017

Skup
Tečaj trajne medicinske izobrazbe 6. E kongres: Prikazi slučajeva iz kliničke prakse u endokrinologiji i dijabetologiji

Mjesto i datum
Zagreb, Hrvatska, 07.04.2017

Vrsta sudjelovanja
Plenarno

Vrsta recenzije
Nije recenziran

Ključne riječi
Šećerna bolest tip 2, metformin, SGLT2 inhibitori, metabolička acidoza, bubrežna insuficijencija, serija bolesnika
(T 2 diabetes mellitus, metformin, SGLT2 inhibitors, metabolic acidosis, renal insufficiencies, case reports)

Sažetak
Metformin, a well-known first-line diabetes therapy, and the recently developed sodium- glucose co-transporter 2 (SGLT2) inhibitor empagliflozin are widely used oral antihyperglycemic drugs in the long-term treatment of type 2 diabetes mellitus (T2DM). Metabolic acidosis is a potentially fatal adverse effect (AE) of these drugs with a high mortality rate. However, the reported incidence of metabolic acidosis in clinical practice has been proven to be very low. Nevertheless, it should be considered that the event rates are based on confounded data and spontaneous case reports. Metformin increases plasma lactate levels by inhibiting mitochondrial respiration, which, accompanied by elevated plasma metformin concentrations (in renal impairment) and a secondary event that further disrupts lactate production (e.g., hypoperfusion, sepsis), typically leads to metformin-associated lactic acidosis (MALA). At the same time, SGLT2 inhibitors are thought to promote ketogenesis and precipitate ketoacidosis by their extra- pancreatic glucuretic mode of action. The present article describes 3 patients suffering from severe metabolic acidosis caused by metformin or empagliflozin, presents similar cases reported in the literature, and assesses the possible etiopathogenesis of the metabolic derangement. Diabetic patients should be educated about the importance of regular fluid and food intake as well as regular blood and urine glucose and ketone self-checkups, whereas physicians should be more aware that the key to an effective use of all glucose-lowering medication is appropriate patient selection, counseling, and follow-up. It is a good clinical sense which will ensure that physicians are able to translate pharmaceutical advances into clinical benefits for patients with T2DM.

Izvorni jezik
Hrvatski

Znanstvena područja
Kliničke medicinske znanosti

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