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1. Metformin-associated lactic acidosis exacerbated by acute kidney injury in an overseas traveler

Author

Akihiro Hamasaki, Tatsuo Tsukamoto, Ayano Hayashi, Hisashi Sugimoto, Takuya Ishimura, and Hiroyuki Suzuki

Subjects
Male, Hyperkalemia, medicine.medical_treatment, Angiotensin-Converting Enzyme Inhibitors, medicine, Humans, Hypoglycemic Agents, Diuretics, Aged, Respiratory distress, business.industry, Acute kidney injury, General Medicine, Acute Kidney Injury, medicine.disease, Metformin, Lactic acidosis, Anesthesia, Acidosis, Lactic, Female, Anuria, Hemodialysis, medicine.symptom, Severe lactic acidosis, business, medicine.drug
Abstract

We report the case of metformin-associated lactic acidosis (MALA) exacerbated by acute kidney injury (AKI) in a 65-year-old Asian American woman who was an overseas traveler. She had vomiting and diarrhea before arriving in Osaka, Japan, from the Philippines. She suffered from worsening respiratory distress, consciousness loss and anuria the day after coming to Japan. When she arrived at our emergency room via ambulance, she appeared to be in a state shock. Arterial blood gas analysis revealed severe lactic acidosis (pH 6.681, PO2 302 Torr under O2 supplementation, PCO2 15 Torr, HCO3−1.7 mmol/L, and lactate 17.00 mmol/L). She also had renal failure (BUN 108 mg/dL and serum creatinine 8.68 mg/dL) with hyperkalemia (6.1 mEq/L). We collected medical information from family members, and found her prescription medicines including metformin, diuretics and angiotensin-converting enzyme inhibitor (ACEI). We diagnosed her with MALA due to an unintended overdose of metformin resulting from acute kidney injury that can be induced by ACEI and diuretics in the volume-depleted condition. We immediately started hemodialysis therapy. Although she had a temporary cardiopulmonary arrest at the beginning of the treatment, her physical status was gradually improved and the severe acidemia resolved. On hospital day 4, she had urine and no longer needed hemodialysis therapy. On day 14, she was discharged and returned to the United States without noticeable sequelae. This is a case report of an overseas traveler who was successfully rescued through the collection of accurate medical information and understanding of the pathological condition.

Published
2021
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2. Polycystic liver disease with lethal abdominal wall rupture: a case report

Author

Tatsuo Tsukamoto, Daichi Akuzawa, Takuya Ishimura, Yoichiro Uchida, Naomi Matsuzaki, Hiroko Kakita, Tomomi Endo, and Hiroaki Terajima

Subjects
0301 basic medicine, medicine.medical_specialty, Abdominal pain, medicine.medical_treatment, 030232 urology & nephrology, Autosomal dominant polycystic kidney disease, Liver transplantation, Abdominal wall, 03 medical and health sciences, 0302 clinical medicine, Abdominal wall herniation, Laparotomy, Case report, medicine, Humans, business.industry, Cysts, Polycystic liver disease, Liver Diseases, Abdominal Wall, General Medicine, Middle Aged, medicine.disease, Polycystic Kidney, Autosomal Dominant, Surgery, 030104 developmental biology, medicine.anatomical_structure, Quality of Life, Medicine, Female, Liver function, Hepatic Cyst, medicine.symptom, business
Abstract

Background Polycystic liver disease is a clinical feature of autosomal dominant polycystic kidney disease, and it can sometimes cause health damage more serious than polycystic kidney. Dialysis therapy can be used for renal failure, but liver transplantation is the only method available for liver failure. Thus, giant and multiple hepatic cysts may affect mortality. However, liver transplantation is not indicated in many cases because of the preserved liver function. Case presentation A 54-year-old Japanese woman with polycystic liver disease was transferred back to our hospital for abdominal pain caused by liver cyst infection with abdominal wall herniation. She had been diagnosed with polycystic liver disease associated with sporadic autosomal dominant polycystic kidney disease 25 years earlier. Although she had several surgical interventions to reduce her liver volume, including right hepatic lobectomy and fenestration for liver cysts in another hospital, she needed further repair of the recurrent incisional herniation with patch graft surgery using fascia lata to cover the herniation site. However, new herniation sites reemerged in the fragile abdominal wall area around the patch, and therefore, she reduced the recurrent abdominal wall herniation by herself. Recurrent intestinal obstructions were luckily released by fasting with decompression treatment via nasogastric tube insertion, but multiple skin ulcers around the enlarged hernia sac gradually developed, and ascites was extremely difficult to control with any medication. At final admission, her abdominal wall was even more prominent, causing shortness of breath, and it spontaneously ruptured many times, which was accompanied by discharge of around 5 liters of ascites each time. She died from sepsis caused by drug-resistant Enterococcus. Conclusions We report a case of autosomal dominant polycystic kidney disease with ruptured abdominal wall resulting from a hepatic cyst enlargement despite multiple laparotomy operations. Throughout the entire disease course, her liver volume increased rapidly, and her quality of life was severely impaired, but she could not undergo liver transplantation after readmission to our hospital. We will discuss the therapeutic strategy for this patient, including the timing and indication for liver transplantation.

Published
2021

3. Diabetes mellitus - basic research

Author

Sara Cattaneo, Keisuke Satoh, Li Ying, Renate Koppensteiner, Cassia Toledo Bergamaschi, Akira Nishiyama, Ma. Lorena Roldán, Andrew P. Levy, Lislaine A. Wensing, Francesca D'Addio, Maki Takeuchi, Piergiorgio Messa, Benedita Sampaio-Maia, Shigetaka Yoshida, Yoko Saito, Andrea Remuzzi, Hitoshi Nakashima, Elisa Mieko Suemitsu Higa, Maho Watanabe, Fabiola Carrara, Caihong Zeng, Nakhoul Nakhoul, Margaret Gori Mouro, Daniela Corna, Rabea Asleh, Miki Nagase, Hideharu Tanaka, Liliana A. Monasterolo, Romina Pagotto, Michael Brownlee, Jun Okabe, Bi-Cheng Liu, Sho-ichi Yamagishi, Hyung Wook Kim, Mark E. Cooper, Gabriel Cao, Yasuo Kawaba, Carine Prisco Arnoni, Jonathan Barasch, Guoping Zheng, Min Li, Hirotaka Imamaki, Luciana G. Pereira, Akira Sugawara, Masakazu Kohno, Yixin Qian, Tomoko Kawanishi, Manuel Pestana, Hui-Ping Chen, Franck Molina, Silvia Armelloni, Rui Alves, Yanna Dou, Wei-Song Qin, Shinichi Okada, Juliana L. Dreyfuss, Zhangsuo Liu, Seok Joon Shin, Hidenori Arai, Casandra Margarita Monzón, Daniela Rottoli, Reza Abdi, Shan Mou, Alexandre H. Campos, Toru Kita, Li Ya, Hiroshi Kanamori, Yong Gu, Thomas Hoertenhuber, Natsuko Iga, Catia Cerqueira, Shigeru Shibata, Marina Munoz, Maria Pia Rastaldi, Mi Lee, Joanne K. Ferguson, Chi-Chih Hung, Andrea Vergani, Fabio Sangalli, Yiping Wang, Elena Gagliardini, Hassan Kulaksiz, Yukako Kinoshita, Nicolas Salvetat, Li Zhang, Tullio Bertani, Antonio Cabrita, Young Ae Kang, Vincent Lee, Takashige Kuwabara, Daisuke Nakano, Mollie Jurewicz, Toshiro Fujita, Hyun Wha Chung, Rachel Miller-Lotan, Kiyoshi Mori, Muh Geot Wong, Motoaki Saito, Lei-Shi Li, Paula Serrao, Eman El Eter, Yan Qiu, Yi-Mei Hong, Hung-Chun Chen, Christina Maeda Takiya, Romano Nosadini, Birgit Rami, David Harris, Florian Hoellerl, Weier Qi, Zhihong Liu, Ryuji Iwatani, Y. Ogawa, Emi Kazuyama, Mirian A. Boim, Tetsuya Nagae, Kanako Matsubara, Qing Li, Giacomo Garibotto, Li-Min Xu, Kenji Ito, Xiao Ru Huang, Steven J. Harper, Giuseppe Remuzzi, Adelson Marçal Rodrigues, Jiaze Li, Hong-Lang Xie, Takashi Oite, Takuya Ishimura, Margarita Angerosa, Rodrigo Tambellini, Claude Granier, Liu Maodong, Yanling Zhang, Yong-Chun Ge, Ayako Fujimi, Dong Zheng, Yoshimi Takamiya, Mohamed H. Sayegh, Yu-Chi Cheng, Sara Conti, Qingxian Zhang, Hye Kyoung Song, Yu-Yan Fan, Jackson Souza-Menezes, Masashi Mukoyama, Hideki Yokoi, Xin Ming Chen, Ma. Mónica Elías, Zhai Shana, Melina A. Pagotto, Lorena Longaretti, Yonghong Shi, Assam El-Osta, Carol A. Pollock, Zanzhe Yu, Jad Kheir, Yoon Sik Chang, Takao Saito, Maha El Enazy, Laura Giardino, Ya Wang, Aneta Balcerczyk, Raquel C. Castiglione, Alessio Mocci, Sharma Prabhakar, Piotr Ksiazek, Ariela Benigni, Carla Zoja, Edith Schober, Shi Yonghong, Yan Sun, Duo Li, Wei-Wei Zhu, Yi-chun Tsai, Stephen I. Alexander, Seiya Okuda, Qi Cao, Edgar Maquigussa, Cheol Whee Park, Sara Molinas, Takako Mizutani, Kei Fukami, Yusuke Kaida, Paulo Roberto Santos, Jee Han, Lin Tang, Wakako Kawarazaki, Noriko Satoh, Alex Yuri S. Sato, Hui Y. Lan, Anabela Almeida, Zhang Yanling, Zhaohui Ni, David Barit, Susumu Kanzaki, Jiaqi Qian, Yukinori Tamura, Farid Nakhoul, David O. Bates, Fernando Dominici, Arthur C.K. Chung, Shirine Dada, Ying Li, Ji Hee Lim, Leyi Gu, Zhao-Hong Chen, Gastón Rojic, Sungjin Chung, Paolo Fiorina, Felipe M. Ornellas, Dae Cha, Roy Asaf, Huili Dai, Itaru Satoh, Laura Trumper, Masato Kasahara, Kazuwa Nakao, Jorge Giani, Carolina M.L. Barbosa, Oh Yeun Kwon, Atsushi Fukatsu, Jorge Toblli, Weiming Zhan, Alexander J. Szalai, Hoda Awad, Kiyomi Koike, Atsushi Hayashi, Shanyan Lin, Yucheng Yan, Fei Liu, Anna Watson, Sabine Peres, Jun Gao, Andrew H.J. Salmon, Faical Jarraya, Karin Jandeleit-Dahm, Monica Moreira-Rodrigues, Omar P. Pignataro, Gerit-Holger Schernthaner, Andrea Augello, Guntram Schernthaner, Giuseppe Garigali, Marcelo M. Morales, Michal Dragan, Hiroyuki Kobori, Monika Buraczynska, Grazyna Orlowska-Kowalik, Daniella Brasacchio, Janete Quelhas-Santos, Tatiana Maron-GutierrezGutierrez, Seiji Ueda, and Guo Quin Wang

Subjects
Transplantation, medicine.medical_specialty, Nephrology, business.industry, Basic research, Diabetes mellitus, Medicine, business, Intensive care medicine, medicine.disease
Published
2009
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