Ugeskrift for laeger
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Ugeskrift for laeger · Jun 2012
Case Reports[Metformin-associated lactic acidosis can be treated with continuous renal replacement therapy].
Metformin is widely used to treat diabetes. In rare cases, metformin may cause lactic acidosis, especially when administered during periods of dehydration. We present two cases of metformin-associated lactic acidosis (MALA). ⋯ Lactate and metformin can be removed effectively by haemofiltration. CRRT is widely available and a well-known treatment at intensive care units. MALA shows a mortality rate of about 30%.
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Ugeskrift for laeger · Jun 2012
[Glucagon-like peptide 1 analogues in the treatment of type 2 diabetes mellitus].
A Cochrane analysis concluded that glucagon-like peptide-1 (GLP-1) analogues were effective for the improvement of glycaemic control in patients with type 2 diabetes. What is the significance for the treatment of Danish patients with type 2 diabetes? In Denmark, two drugs exist, exenatid and liraglutid, and they both reduce HbA1c with approx. 1%. Compared with sulfonylurea and insulin, the advantage of GLP-1 analogues is not only that they rarely induce hypoglycaemia, but also that body weight is reduced. On the other hand, no long-term results exist with regard to impact on the cardiovascular system, and no complete overview of possible side effects has been presented either.
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Since postoperative pain often is undermanaged, and opioids, although being efficient analgesics, have undesirable side effects, attention has turned towards adjuvant therapies, among them nicotine. We present seven studies of which six show an effect of nicotine on postoperative pain when given in a low dose, with short time of exposure and to non-smokers. ⋯ Nicotine seems to increase the occurrence of nausea and vomiting. More research is needed, and nicotine cannot currently be recommended as part of a multimodal pain management regime.