Dr Valérie Gras-Champel Clinical Pharmacology University Hospital of Amiens Amiens, France	Prof Z.A. Massy Nephrology and Clinical Pharmacology Departments University Hospital of Amiens Amiens, France

 

 

An 85-year-old woman weighing 65kg, was admitted to the intensive care unit of our hospital for vomiting, abdominal pain, discomfort, confusion and dyspnea, which had lasted for 48 hours. She had a history of diarrhea several days before her admission with favorable spontaneous evolution. At this time she self-administered aspirin (3g/day) for a few days. She was currently being treated with metformin (2 x 850 mg/day) and simvastatin (10 mg/day) for type-2 diabetes and hypercholesterolemia respectively.
At admission, physical examination showed body temperature of 37°, and normal blood pressure. Plasma electrolyte levels were considered normal: sodium=145 mEq/L; potassium=5.1 mEq/L, chloride=102 mEq/L. Arterial blood gas analysis showed: pH=7.1; pCO2 =14.4 mmHg; pO2=134.2 mmHg; HCO3-=4.4 mmol/L. Additional blood tests demonstrated: creatininemia=130 µmol/L; glucose = 5 mmol/L; blood lactatemia=33 mmol/L; ketonemia= 0.3 mmol/L, ketonuria=1.10 mmol/24h; transaminases=120 UI/L; TP=90%. White blood cells=5200/mm3.

Chemical structure of two members of the biguanid family.

 

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Acknowledgements: The author is indebted to Prof Michel Andrejak, and Dr Henri Masson for revising the manuscript and making useful suggestions, as well as Prof Jean-Daniel Lalau for his useful help regarding the bibliography.