Accepted Manuscript Title: Acute renal failure and Metformin-associated Lactic Acidosis following ColonoscoPlease provide a reduced form of the main title that doesn’t exceed 80 characters.–>Acute renal failure and Metformin-associated Lactic Acidosis following Colonosco–>py Author: Mohammad I. Hussain Bruce M. Hall Barbara Depczynski Susan J. Connor PII: DOI: Reference:
S0168-8227(14)00016-3 http://dx.doi.org/doi:10.1016/j.diabres.2013.12.055 DIAB 5974
To appear in:
Diabetes Research and Clinical Practice
Received date: Revised date: Accepted date:
24-3-2013 31-8-2013 28-12-2013
Please cite this article as: M.I. Hussain, B.M. Hall, B. Depczynski, S.J. Connor, Acute renal failure and Metformin-associated Lactic Acidosis following Colonoscopy, Diabetes Research and Clinical Practice (2014), http://dx.doi.org/10.1016/j.diabres.2013.12.055 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
TITLE PAGE
Mohammad I Hussain
us
(including middle initial):
cr
1st Author Name
ip t
Manuscript Title: Acute renal failure and Metformin-associated Lactic Acidosis following Colonoscopy
MBBS
Position:
Advance Trainee
Department:
Age care department
Institution or Affiliation:
Liverpool Hospital
Address:
Liverpool Hospital, Liverpool, NSW 2170
Country:
Australia
M
d
Ac ce p
2nd Author Name
[email protected]
te
Email:
an
Qualifications:
Bruce M. Hall
(including middle initial): Qualifications:
MB BS FRACP PhD
Position:
Professor of Medicine
Department:
Medicine
Institution or Affiliation:
University of New South Wales
Address:
Liverpool Hospital, Liverpool, NSW, 2170
Country:
Australia
Email:
[email protected]
Page 1 of 8
2
3rd Author Name
Barbara Depczynski
(including middle initial): MBBS PhD FRACP
Position:
Endocrinologist
Department:
Diabetes and Endocrinology
Institution or Affiliation:
Prince of Wales Hospital
Address:
Barker Street, Randwick, NSW 2031
Country:
Australia
Email:
[email protected]
4th Author Name
Susan J Connor
cr
us
an
M
(including middle initial):
ip t
Qualifications:
MBBS (Hons 1) BMed Sci FRACP PhD
Position:
Staff Specialist Gastroenterology and Hepatology
te
Department:
d
Qualifications:
Ac ce p
Institution or Affiliation:
Liverpool Hospital
Address:
Locked Bag 7103, Liverpool BC, NSW 1871
Country:
Australia
Email:
[email protected]
Page 2 of 8
3
Brief report
ip t
Acute renal failure and Metformin-associated Lactic Acidosis following Colonoscopy
Abstract
cr
Two patients with type 2 DM developed acute kidney injury and lactic acidosis following
us
colonoscopy despite withholding metformin. We recommend that DM patients on metformin also withhold ACEI, ARB until their dehydration is reversed after colonoscopy. This should
Presentation of cases
M
1.
an
reduce the risk of acute renal failure (ARF) and of lactic acidosis.
The first patient was a 67 year old man who had a 22 year history of type 2 diabetes and had
d
many complications of diabetes including diabetic nephropathy with mild chronic kidney
te
disease. Six weeks prior to colonoscopy his serum creatinine was 118μmol/L, eGFR 57
Ac ce p
ml/min/1.73m2, microalbumin:creatinine ratio 11.6mg/mmol creatinine [reference range (RR), ≤2.5]). His HbA1c was 7.9% (63mmol/mol). Other diabetes associated complications included diabetic retinopathy, peripheral neuropathy, cerebrovascular disease and ischaemic heart disease. He had undergone surgery for a rectal adenocarcinoma 2 years prior. He presented to emergency with 7 hours of central chest pain, and 5 days of nausea and vomiting. A colonoscopy 12 days prior found 2 adenomas that were removed. The bowel preparation used included sodium picosulphate. Metformin 1000mg bd was withheld the day prior to and of the colonoscopy. He was continued on his other regular medication of gliclazide
160mg
bd,
and
isophane
insulin
30
units
nocte, perindopril
5mg,
Page 3 of 8
4
indapamide2.5mg, pantoprazole 40mg, allopurinol 300mg, felodopine2.5 mg, warfarin 5mg, atorvastatin 80mg and fluoxetine 20mg. At presentation he was dehydrated and his heart rate was 110 beats/minute, blood pressure His serum sodium was 139mmol/L (RR, 135-
ip t
140/90mmHg and respiratory rate 40/minute.
145), potassium 6.4mmol/L (RR, 3.5-5.0), chloride 92mmol/L (RR, 97-109), bicarbonate
cr
S0168-8227(14)00016-3 http://dx.doi.org/doi:10.1016/j.diabres.2013.12.055 DIAB 5974
To appear in:
Diabetes Research and Clinical Practice
Received date: Revised date: Accepted date:
24-3-2013 31-8-2013 28-12-2013
Please cite this article as: M.I. Hussain, B.M. Hall, B. Depczynski, S.J. Connor, Acute renal failure and Metformin-associated Lactic Acidosis following Colonoscopy, Diabetes Research and Clinical Practice (2014), http://dx.doi.org/10.1016/j.diabres.2013.12.055 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
TITLE PAGE
Mohammad I Hussain
us
(including middle initial):
cr
1st Author Name
ip t
Manuscript Title: Acute renal failure and Metformin-associated Lactic Acidosis following Colonoscopy
MBBS
Position:
Advance Trainee
Department:
Age care department
Institution or Affiliation:
Liverpool Hospital
Address:
Liverpool Hospital, Liverpool, NSW 2170
Country:
Australia
M
d
Ac ce p
2nd Author Name
[email protected]
te
Email:
an
Qualifications:
Bruce M. Hall
(including middle initial): Qualifications:
MB BS FRACP PhD
Position:
Professor of Medicine
Department:
Medicine
Institution or Affiliation:
University of New South Wales
Address:
Liverpool Hospital, Liverpool, NSW, 2170
Country:
Australia
Email:
[email protected]
Page 1 of 8
2
3rd Author Name
Barbara Depczynski
(including middle initial): MBBS PhD FRACP
Position:
Endocrinologist
Department:
Diabetes and Endocrinology
Institution or Affiliation:
Prince of Wales Hospital
Address:
Barker Street, Randwick, NSW 2031
Country:
Australia
Email:
[email protected]
4th Author Name
Susan J Connor
cr
us
an
M
(including middle initial):
ip t
Qualifications:
MBBS (Hons 1) BMed Sci FRACP PhD
Position:
Staff Specialist Gastroenterology and Hepatology
te
Department:
d
Qualifications:
Ac ce p
Institution or Affiliation:
Liverpool Hospital
Address:
Locked Bag 7103, Liverpool BC, NSW 1871
Country:
Australia
Email:
[email protected]
Page 2 of 8
3
Brief report
ip t
Acute renal failure and Metformin-associated Lactic Acidosis following Colonoscopy
Abstract
cr
Two patients with type 2 DM developed acute kidney injury and lactic acidosis following
us
colonoscopy despite withholding metformin. We recommend that DM patients on metformin also withhold ACEI, ARB until their dehydration is reversed after colonoscopy. This should
Presentation of cases
M
1.
an
reduce the risk of acute renal failure (ARF) and of lactic acidosis.
The first patient was a 67 year old man who had a 22 year history of type 2 diabetes and had
d
many complications of diabetes including diabetic nephropathy with mild chronic kidney
te
disease. Six weeks prior to colonoscopy his serum creatinine was 118μmol/L, eGFR 57
Ac ce p
ml/min/1.73m2, microalbumin:creatinine ratio 11.6mg/mmol creatinine [reference range (RR), ≤2.5]). His HbA1c was 7.9% (63mmol/mol). Other diabetes associated complications included diabetic retinopathy, peripheral neuropathy, cerebrovascular disease and ischaemic heart disease. He had undergone surgery for a rectal adenocarcinoma 2 years prior. He presented to emergency with 7 hours of central chest pain, and 5 days of nausea and vomiting. A colonoscopy 12 days prior found 2 adenomas that were removed. The bowel preparation used included sodium picosulphate. Metformin 1000mg bd was withheld the day prior to and of the colonoscopy. He was continued on his other regular medication of gliclazide
160mg
bd,
and
isophane
insulin
30
units
nocte, perindopril
5mg,
Page 3 of 8
4
indapamide2.5mg, pantoprazole 40mg, allopurinol 300mg, felodopine2.5 mg, warfarin 5mg, atorvastatin 80mg and fluoxetine 20mg. At presentation he was dehydrated and his heart rate was 110 beats/minute, blood pressure His serum sodium was 139mmol/L (RR, 135-
ip t
140/90mmHg and respiratory rate 40/minute.
145), potassium 6.4mmol/L (RR, 3.5-5.0), chloride 92mmol/L (RR, 97-109), bicarbonate
cr
