both very common and widely prescribed agents for bowel preparation and diabetes control, respectively. Renal damage after usage of OSP and lactic acidosis after metformin are both well recognized adverse effects. Hence, there are regulations for each of these two agents to limit their use in specific populations. However, the safety of OSP usage in patients taking metformin is seldom discussed...

Hypertonic glucose, fructose, and sorbitol solutions were given intravenously to women in the first stage of labour who had ketonuria and ketonaemia as evidenced by a raised blood acetoacetate and 3-hydrosybutyrate. There was no difference in the antiketogenic action of these, which was rapid and effective, but when compared with a control group who were given normal saline they had a high inci...

We have developed a novel, rapid microassay for dichloroacetate in the serum. The serum sample is directly injected into a gel-permeation high-performance liquid chromatography apparatus. The peak of dichloroacetate appears after a giant protein peak. The method requires a very small amount of serum (10 microliters), and the analysis time is short (20 min). Using this micro method, we measured ...

This article discusses the case of a 68-year-old emergency department patient with hypoglycaemia, hypotension, unconsciousness and a severe metabolic acidosis. It transpired that she had type 2 diabetes mellitus, which she managed with metformin, and ED staff thought initially that her acidosis was caused by rhabdomyolysis. However, a number of anomalies were identified and after further consid...

In this article, on page 204, the title has been spelled incorrectly: " MEALS " should have appeared as " MELAS ". The title should be corrected as the following: from " A Case of Myopathy, Encephalopathy, Lactic Acidosis and Stroke-like Epicodes (MEALS) Syndrome with Intracardiac Thrombus " to " A Case of Myopathy, Encephalopathy, Lactic Acidosis and Stroke-like Epicodes (MELAS) Syndrome with ...

We report a case of metformin-associated lactic acidosis (MALA) in the setting of normal renal function and review the relevant medical literature. A 77-year-old female diagnosed with type 2 diabetes mellitus previously treated with insulin and gliclazide MR was started on metformin. A few weeks later, she was found to have lactic acidosis. Renal function was normal, and no severe underlying il...

Metformin is a biguanide, insulin sensitiser that reduces blood sugar levels. There are concerns about the risk of lactic acidosis in patients receiving metformin who have procedures requiring iodinated contrast, and in those with renal impairment or heart failure. The data on which these concerns are based are reviewed, with the conclusion that metformin treatment is rarely to blame for lactic...

Early-onset mitochondrial encephalomyopathy is a rare disorder that presents in the neonatal period with lactic acidosis, hypotonia, and developmental delay. Sequence variants in the nuclear-encoded gene FBXL4 have been previously demonstrated to be a cause of early-onset mitochondrial encephalomyopathy in several unrelated families. We have identified a pair of siblings with mutations in FBXL4...

Major strides have been made in improving the treatment of medical emergencies associated with malignancies. Nonetheless, metabolic emergencies in cancer patients can often times be life-threatening. Type B lactic acidosis is a rare but potentially fatal paraneoplastic phenomenon that has been described in association with hematologic and solid malignancies and portends a poor prognosis if not ...

Metabolic acid-base disorders are comnom clinical problems in ICU patients. Arterial blood gas analysis and anion gap (AG) are important laboratory data in approaching acid-base interpretation. When measuring the AG, several factors such as albumin have influence on unmeasured anions and unmeasured cations. If a patient has hypoalbuminemia, the AG should be adjusted according to the albumin lev...