Der Internist
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Many, different diseases can result in pulmonary fibrosis and its prevalence is continuously increasing. Pulmonary fibrosis is defined by a diffuse accumulation of connective tissue in the interstitial space resulting in destruction of lung parenchyma. Older individuals are more often affected by this disease than younger. ⋯ Now 6 different types of interstitial pneumonia according to 6 different pathologic patterns are newly defined. Still, there is no efficient treatment known, which resolves fibrotic lung remodeling. However, immunosuppressive treatment strategies are established in pulmonary fibrosis evoked by inflammatory processes.
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In case of impaired consciousness, metabolic acidosis with wide anion gap and elevated lactate levels a metformin associated lactic acidosis should be considered in diabetic patients. Taking into account the contraindications to metformin, lactic acidosis is a rare complication, however - if it occurs - fatal in 50-80%. The outcome of the surviving patients is good, once the acute stage is outlived due to immediate hemofiltration.