Discontinuation of the causative agent is imperative in drug-induced metabolic acidosis
- PDF / 98,373 Bytes
- 4 Pages / 612.28 x 790.87 pts Page_size
- 108 Downloads / 147 Views
Discontinuation of the causative agent is imperative in drug-induced metabolic acidosis Metabolic acidosis, a common condition in critically ill patients, is associated with several medical disorders and may also be caused by a number of commonly prescribed drugs. In all cases of drug-induced metabolic acidosis, treatment with the causative drug should be discontinued and re-administration avoided.
Acid-base equilibrium is disturbed Metabolic acidosis is a disturbance in the systemic acid-base equilibrium (i.e. the relationship between H+ and HCO3 -).[1] It is characterized by a primary decrease in serum HCO3 - levels and a secondary, compensatory decrease in the arterial partial pressure of CO2 and blood pH.[2] Normal blood pH is maintained by the kidneys (reabsorption of filtered HCO3 + and excretion of H+ load), the lungs (expiration of CO2) and extracellular and intracellular buffers.[1,3]
y but also associated with certain drugs Occasionally, metabolic acidosis may develop in patients receiving drugs used in everyday clinical practice, as well as in individuals exposed to certain chemicals. This article provides an overview of the recent review on pharmacologically induced metabolic acidosis by Liamis et al.[1] Severe acidaemia has several adverse effects on organ and cellular function, particularly on the cardiovascular, central nervous, gastrointestinal and metabolic systems.[3] Some examples include decreased cardiac output, a predisposition to cardiac arrhythmias and decreased peripheral vascular resistance, leading to hypotension and resistance to cathecholamines and insulin.[3] Although drug-induced metabolic acidosis is usually of mild severity, some cases are severe and may even be fatal (e.g. lactic acidosis caused by biguanide and antiretroviral therapy).[1] The severity of metabolic acidosis (i.e. pH) is correlated with mortality.[5]
Typically seen in the unwell y Metabolic acidosis often develops in critically ill patients.[1,2] A retrospective analysis of 9799 intensive care unit patients reported that 64% had metabolic acidosis.[4] Several medical disorders (e.g. acute kidney injury, chronic kidney disease, diarrhoea, primary or secondary adrenal insufficiency, and intestinal, pancreatic or biliary fistulae) may result in metabolic acidosis.[2] The symptoms of the subsequent metabolic disease typically relate to the underlying cause.[1]
Risk with drugs increased in some patients The risk of metabolic acidosis associated with the use of certain drugs, including antiretrovirals, biguanides, paracetamol (acetaminophen) and propylene glycol-containing drugs may be increased by various patient factors, such as renal or hepatic impairment, age or combination therapy with other drugs that have the potential to induce metabolic acidosis (table I).[1]
Table I. Predisposing risk factors associated with metabolic acidosis induced by certain drugs[1] Drug(s)
Renal
Hepatic
impairment
impairment
Alcoholism Age/sex/ pregnancy
Severe
Combination
Other
underlying
therapy
conditions
>1 antiretrovi
Data Loading...
