[Insufficient correction of blood bicarbonate levels in biguanide lactic acidosis treated with CVVH and bicarbonate replacement fluids].
BACKGROUND
In the course of Continuous Veno-Venous Hemofiltration (CVVH), bicarbonate buffer instead of lactate is suitable for the treatment of combined renal and hepatic failure and for patients suffering from lactic acidosis, type A or B, joined with acute renal failure (ARF).


METHODS
We applied the CVVH buffered with bicarbonate for the treatment of two patients affected by ARF and severe lactic acidosis type B (due to biguanide intoxication) and we evaluated its ability to correct the acid-base balance.


RESULTS
Clinical and laboratory data show that this technique, performed in standard conditions (plasma flow: 70 ml/min, ultrafiltration: 25 ml/min, bicarbonate concentration in the infusion fluid: 30 mEq/L), was inadequate to compensate for the high requirement of bicarbonate (approximately 280 mEq/hr during the first 6 hours of observation) and the severe metabolic acidosis, thus additional bicarbonate infusion was needed.


CONCLUSIONS
In particular, from ascertained data and theoretical considerations, in the course of lactic acidosis caused by biguanide, in order to correct acidosis a positive balance of bicarbonate could be obtained only by means of a bicarbonate-based replacement fluid and of a continuous high flow hemofiltration, such as to assure an ultrafiltrate volume exceeding 150 ml/min.
Mariano
F
F
Servizio di Nefrologia e Dialisi, Ospedale S. Lazzaro, Alba, Cuneo.
Goia
F
F
Vincenti
R
R
Capra
L
L
Lanza
G
G
Curto
V
V
Cavalli
P L
PL
D000140:Acidosis, Lactic / Q000097:blood* / Q000139:chemically induced; D058186:Acute Kidney Injury / Q000097:blood / Q000628:therapy; D000368:Aged; D001639:Bicarbonates / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use*; D002021:Buffers; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D005260:Female; D005440:Fluid Therapy; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D010629:Phenformin / Q000009:adverse effects*
D001639:Bicarbonates; D002021:Buffers; D007004:Hypoglycemic Agents; D010629:Phenformin