Arch Intern Med
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Review Case Reports
Biguanide-associated lactic acidosis. Case report and review of the literature.
The biguanides are a class of oral hypoglycemic agents that are commonly used in the treatment of diabetes mellitus. Such agents include metformin, phenformin, and buformin. The use of phenformin was discontinued in the United States in 1976 because of probable association with lactic acidosis. However, metformin is currently in common use in many parts of the world. In this report, we describe a patient with severe lactic acidosis secondary to metformin administration, and review the literature relevant to biguanide-associated lactic acidosis. ⋯ Lactic acidosis can complicate biguanide therapy in diabetic patients with renal insufficiency. We review the literature relevant to the pathogenesis and therapy of biguanide-associated lactic acidosis. Physicians who have completed their training after 1976 may not be familiar with metformin and other biguanides, but with the increasing numbers of immigrants to the United States, physicians should be aware of the potential complications of these medications.
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Although cardiopulmonary resuscitation (CPR) has been shown to be most effective in a monitored setting, previous studies have focused primarily on patients with acute cardiac events rather than chronic progressive disease. This study examined the outcome of CPR in the medical and surgical intensive care units where patients often have acute illness superimposed on chronic underlying conditions. ⋯ Patients with chronic medical conditions undergoing CPR even in an intensive care unit setting seldom survive to hospital discharge. Even among the few survivors, the near term prognosis is poor. Therefore, the decision to perform CPR should take into account underlying chronic medical conditions and not merely the setting of the arrest.