PURPOSE: To investigate the association of diabetes mellitus and metformin use with metabolic acidosis risk after radical cystectomy (RC) and urinary diversion for bladder cancer. MATERIALS AND METHODS: This retrospective cohort study used TriNetX Research Network data. Patients undergoing RC with continent diversion or ileal conduit for bladder cancer were identified using International Classification of Diseases, 10th Revision (ICD-10) and ICD-10 Procedure Coding System (ICD-10-PCS) codes. The primary outcome was acidosis between 1 month and 3 years postsurgery. Risk ratios (RR) and odds ratios (OR) were calculated based on diabetes and metformin use, stratified by diversion type and chronic kidney disease stage. Propensity score matching balanced potential confounders. RESULTS: We identified 1,986 patients who underwent continent diversion and 11,184 who underwent ileal conduit reconstruction. In matched analyses, diabetes patients had higher acidosis risk (continent diversion: RR 1.87, 95% confidence interval [CI] 1.39-2.51; ileal conduit: RR 1.94, 95% CI 1.66-2.27). The risk was highest for diabetes patients with metformin prescription (continent diversion: RR 2.06, 95% CI 1.63-2.61; ileal conduit: RR 2.13, 95% CI 1.84-2.47). However, among patients with diabetes, metformin use did not significantly affect acidosis rates in most analyses. Continent diversion patients had higher acidosis risk than ileal conduit patients (RR 1.89, 95% CI 1.58-2.26). CONCLUSION: Diabetes significantly increases metabolic acidosis risk after RC with urinary diversion, especially in continent diversion patients. While metformin may contribute to metabolic acidosis risk, its impact appears less significant than that of diabetes. Careful monitoring and appropriate metformin adjustments are crucial in this population.

• Keywords
• Bladder cancer, Complication, Diabetes mellitus, Metabolic acidosis, Metformin, Radical cystectomy, Urinary diversion,
• MeSH
• Acidosis * etiology   epidemiology   chemically induced   MeSH
• Cystectomy * adverse effects   methods   MeSH
• Urinary Diversion * adverse effects   methods   MeSH
• Hypoglycemic Agents * adverse effects   therapeutic use   MeSH
• Middle Aged MeSH
• Humans MeSH
• Metformin * adverse effects   therapeutic use   MeSH
• Urinary Bladder Neoplasms * surgery   MeSH
• Postoperative Complications * etiology   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH
• Names of Substances
• Hypoglycemic Agents * MeSH
• Metformin * MeSH

Pseudohypoaldosteronism type 2 (PHA2) is a rare inherited condition of altered tubular salt handling. It is characterized by the specific constellation of hyperkalaemic hyporeninemic hypertension, hyperchloremic metabolic acidosis and hypercalciuria. Molecular genetic testing confirms the diagnosis in the majority of cases. Thiazides constitute effective treatment. Due to its rarity, the diagnosis is often delayed. We here present two children with PHA2, who were initially treated with fludrocortisone and bicarbonate complicated mainly by exacerbation of their hypertension. Discontinuation of their previous therapy and commencement of thiazide diuretics led to normalisation of their blood pressure and electrolyte and acid-base status.

• Keywords
• Gordon syndrome, Hyporeninemic hypertension, Pseudohypoaldosteronism type 2, Thiazides,
• MeSH
• Acidosis * diagnosis   etiology   MeSH
• Child MeSH
• Fludrocortisone therapeutic use   MeSH
• Hyperkalemia * diagnosis   etiology   MeSH
• Hypertension * etiology   drug therapy   diagnosis   MeSH
• Blood Pressure * drug effects   MeSH
• Humans MeSH
• Pseudohypoaldosteronism * diagnosis   complications   drug therapy   genetics   physiopathology   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Names of Substances
• Fludrocortisone MeSH

Chronic diarrhea is a significant challenge in clinical practice because of its high prevalence and various causes. Comprehensive clinical assessment and stepwise laboratory approach are crucial for an accurate diagnosis. This report presents a case of an adult woman who experienced chronic watery diarrhea, complicated by renal impairment and multiple electrolyte imbalances, including hypokalemia, hypophosphatemia, and metabolic acidosis. The diagnosis of a vasoactive intestinal polypeptide-secreting tumor (VIPoma) with liver metastases was confirmed by elevated serum levels of a vasoactive intestinal polypeptide (VIP) and imaging findings of a pancreatic mass with multiple hepatic lesions. Preoperative management, including fluid rehydration, electrolyte correction, and somatostatin analog therapy, significantly improved her clinical symptoms. Subsequent surgical tumor removal and radiofrequency ablation of the hepatic lesions resulted in complete resolution of symptoms and normalized VIP levels. This case emphasizes the importance of early recognition of this rare tumor in patients with chronic diarrhea to improve clinical outcomes.

• Keywords
• VIPoma, WDHA syndrome, chronic watery diarrhea, functional neuroendocrine tumor, vasoactive intestinal polypeptide,
• MeSH
• Chronic Disease MeSH
• Vipoma * complications   diagnosis   MeSH
• Middle Aged MeSH
• Humans MeSH
• Liver Neoplasms secondary   complications   MeSH
• Pancreatic Neoplasms * complications   MeSH
• Diarrhea * etiology   MeSH
• Vasoactive Intestinal Peptide blood   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Names of Substances
• Vasoactive Intestinal Peptide MeSH

AIMS: Refractory out-of-hospital cardiac arrest (r-OHCA) in patients with pulmonary embolism (PE) is associated with poor outcomes. The role of extracorporeal cardiopulmonary resuscitation (ECPR) in this patient group is uncertain. This study aims to analyse clinical course, outcomes, and the effect of an invasive procedure, including ECPR, in a randomized population. METHODS AND RESULTS: A post hoc analysis of a randomized controlled trial (Prague OHCA study) was conducted to evaluate the effect of ECPR vs. a standard approach in r-OHCA. A subgroup of patients with PE-related r-OHCA was identified, and procedural and outcome characteristics, including favourable neurological survival, organ donation, and complications, were compared to patients without PE. Pulmonary embolism was identified as a cause of r-OHCA in 24 of 256 (9.4%) enrolled patients. Patients with PE were more likely to be women [12/24 (50%) vs. 32/232 (13.8%); P < 0.001] and presented more frequently with an initial non-shockable rhythm [23/24 (95.8%) vs. 77/232 (33.2%); P < 0.001], as well as more severe acidosis at admission [median pH (interquartile range); 6.83 (6.75-6.88) vs. 6.98 (6.82-7.14); P < 0.001]. Their favourable 180-day neurological survival was significantly lower [2/24 (8.3%) vs. 66/232 (28.4%); P = 0.049], but the proportion of accepted organ donors was higher (16.7 vs. 4.7%, P = 0.04). CONCLUSION: Refractory out-of-hospital cardiac arrest due to PE has a different presentation and inferior outcomes compared to other causes but may represent an important source of organ donations. The ECPR method did not improve patient outcomes.

• Keywords
• cardiac arrest, extracorporeal cardiopulmonary resuscitation, organ donorship, pulmonary embolism,
• MeSH
• Cardiopulmonary Resuscitation * methods   MeSH
• Humans MeSH
• Extracorporeal Membrane Oxygenation * methods   MeSH
• Pulmonary Embolism * etiology   complications   MeSH
• Retrospective Studies MeSH
• Out-of-Hospital Cardiac Arrest * etiology   therapy   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Randomized Controlled Trial MeSH

D-lactic acidosis represents a rare form of metabolic acidosis that occurs most commonly in patients with short bowel syndrome. This is a serious, sometimes life-threatening complication. The cause is the accumulation of D-lactate in the body, which is formed in excessive amounts by fermentation of unabsorbed carbohydrates by the intestinal microbiota. The nervous system is predominantly affected, which also results in clinical manifestations. The clinical picture is dominated by a wide range of non-specific neurological symptoms. The disease can sometimes manifest as somnolence to coma. From the aspect of laboratory diagnostics, the disease is characterized by severe metabolic acidosis with an increased anion gap. In this case report, we present a unique case of a 54-year-old woman with Crohns disease and short bowel syndrome who in a short time was repeatedly hospitalized for recurrence of severe metabolic acidosis with severe impaired consciousness. Based on the evaluation of anamnestic data, clinical picture and laboratory tests, the patient was diagnosed with D-lactic acidosis. In the discussion we discuss the individual steps that led to this diagnosis and compare our experience with data in the world literature.

• Keywords
• D-lactic acidosis, encephalopathy, short bowel syndrome,
• MeSH
• Acidosis, Lactic * complications   diagnosis   MeSH
• Acidosis * MeSH
• Lactic Acid MeSH
• Middle Aged MeSH
• Humans MeSH
• Short Bowel Syndrome * complications   diagnosis   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Names of Substances
• Lactic Acid MeSH

BACKGROUND: Acute renal impairment is a relatively rare complication of anti-tumour immunotherapy. The incidence of renal toxicity due to immuno-oncological therapy is relatively low, approximately 2% in patients treated with PD-1/PD-L1 inhibitors and 4.5% with combination treatments with PD-1/PD-L1 therapy and a CTLA-4 inhibitor. The most common underlying pathology is acute tubulointerstitial nephritis. Autoimmune nephropathy presenting as a electrolyte imbalance may also occur during immuno-oncological therapy. Discontinuation of immunotherapy and corticosteroid therapy are indicated in patients with moderate to severe renal toxicity. CASE: A 61-year-old patient with metastatic renal cell carcinoma was admitted to hospital after 7 months of treatment with nivolumab for general deterioration, severe weakness, nausea, and anorexia. Laboratory examinations showed worsening of the glomerular filtration rate, severe hyperkalaemia, and metabolic acidosis. Thyroid hormone and cortisol levels were within normal ranges. Renal tubular acidosis resulting from immuno-oncological therapy was diagnosed, and treatment with methylprednisolone was initiated. Electrolyte abnormalities and symptoms improved rapidly, after which the dose of prednisone was gradually reduced; however, after a reduction to 5 mg daily, hyperkalaemia recurred and the patient was kept on a maintenance dose of 10 mg prednisone administered orally on a daily basis thereafter. Immunotherapy was not reintroduced. CONCLUSION: Renal toxicity following immuno-oncological therapy usually presents initially as an increase in the serum creatinine level without any clinical signs or symptoms. Electrolyte disturbances, oliguria, anuria, and swelling may develop gradually. Endocrine and metabolic disorders such as new-onset type 1 diabetes mellitus, hypophysitis, adrenal insufficiency, and hypothyroidism should be excluded as possible causes of electrolyte abnormalities. Corticosteroids at the usual immunosuppressive dose are the treatment of choice. The prognosis is generally favourable because renal toxicity responds well to corticosteroid treatment regardless of the underlying pathology.

• Keywords
• corticosteroids, hyperkalaemia, immunotherapy, nephritis,
• MeSH
• Immunotherapy adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Kidney Diseases chemically induced   drug therapy   epidemiology   MeSH
• Prognosis MeSH
• Antineoplastic Agents, Immunological adverse effects   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Review MeSH
• Names of Substances
• Antineoplastic Agents, Immunological MeSH

Lactic acidosis is a feared complication of metformin therapy. In our article we describe 2 case reports of patients treated with metformin, who developed this complication. In the first case, which was fatal, cummulation of lactate was a result of acute kidney failure caused by diarrhea. In the second patient, lactic acidosis developed in the terrain of preexisting chronic kidney disease, when dyspepsia and decreased fluid intake caused progression into acute kidney failure. In this case, treatment of lactic acidosis was successful. Death of the first patient was probably caused by the presence of serious comorbidities and other complications which developed early after her addmission to intensive care unit. Lactic acidosis can be prevented by strict avoidance of metformin use in case of contraindications and interruption of its use during intercurrent disease.

• Keywords
• guidelines, hypoglycemia, lactic acidosis, metformin, renal failure, type 2 diabetes mellitus,
• MeSH
• Acidosis, Lactic * chemically induced   MeSH
• Diabetes Mellitus, Type 2 * complications   drug therapy   MeSH
• Hypoglycemic Agents adverse effects   MeSH
• Contraindications MeSH
• Humans MeSH
• Metformin * adverse effects   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Hypoglycemic Agents MeSH
• Metformin * MeSH

AIMS/HYPOTHESIS: The aim of this work was to evaluate geographical variability and trends in the prevalence of diabetic ketoacidosis (DKA), between 2006 and 2016, at the diagnosis of childhood-onset type 1 diabetes in 13 countries over three continents. METHODS: An international retrospective study on DKA at diagnosis of diabetes was conducted. Data on age, sex, date of diabetes diagnosis, ethnic minority status and presence of DKA at diabetes onset were obtained from Australia, Austria, Czechia, Denmark, Germany, Italy, Luxembourg, New Zealand, Norway, Slovenia, Sweden, USA and the UK (Wales). Mean prevalence was estimated for the entire period, both overall and by country, adjusted for sex and age group. Temporal trends in annual prevalence of DKA were estimated using logistic regression analysis for each country, before and after adjustment for sex, age group and ethnic minority status. RESULTS: During the study period, new-onset type 1 diabetes was diagnosed in 59,000 children (median age [interquartile range], 9.0 years [5.5-11.7]; male sex, 52.9%). The overall adjusted DKA prevalence was 29.9%, with the lowest prevalence in Sweden and Denmark and the highest in Luxembourg and Italy. The adjusted DKA prevalence significantly increased over time in Australia, Germany and the USA while it decreased in Italy. Preschool children, adolescents and children from ethnic minority groups were at highest risk of DKA at diabetes diagnosis in most countries. A significantly higher risk was also found for females in Denmark, Germany and Slovenia. CONCLUSIONS/INTERPRETATION: DKA prevalence at type 1 diabetes diagnosis varied considerably across countries, albeit it was generally high and showed a slight increase between 2006 and 2016. Increased awareness of symptoms to prevent delay in diagnosis is warranted, especially in preschool children, adolescents and children from ethnic minority groups.

• Keywords
• Children with diabetes, Complications, Diabetic ketoacidosis, Diagnosis of diabetes, Epidemiology, Type 1 diabetes,
• MeSH
• Diabetes Mellitus, Type 1 epidemiology   genetics   metabolism   MeSH
• Diabetic Ketoacidosis epidemiology   genetics   metabolism   MeSH
• Child MeSH
• Humans MeSH
• Child, Preschool MeSH
• Retrospective Studies MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Denmark epidemiology   MeSH
• Germany epidemiology   MeSH
• Slovenia epidemiology   MeSH

Lactic acidosis is a rare but serious adverse event linked to treatment with linezolid, an oxazolidinone antibiotic. Presented is a case of a 67-year-old man treated for 26 days with linezolid for staphylococcal osteomyelitis of the right foot with subsequent sepsis. During the course of treatment, severe lactic acidosis developed, requiring hospitalization in an intensive care unit. The likely mechanism of this potentially life-threatening complication is discussed.

• MeSH
• Acidosis, Lactic * diagnosis   etiology   pathology   MeSH
• Anti-Bacterial Agents adverse effects   therapeutic use   MeSH
• Humans MeSH
• Linezolid adverse effects   MeSH
• Osteomyelitis * complications   drug therapy   etiology   MeSH
• Oxazolidinones * MeSH
• Aged MeSH
• Sepsis * etiology   MeSH
• Staphylococcal Infections * complications   drug therapy   etiology   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Review MeSH
• Names of Substances
• Anti-Bacterial Agents MeSH
• Linezolid MeSH
• Oxazolidinones * MeSH

BACKGROUND: Hyperchloremia produces renal vasoconstriction and fall in glomerular filtration rate. In 90% of brain-dead organ donors, diabetes insipidus develops, characterized by inappropriate diuresis, hyperosmolality, and hyperchloremia. The aim of this study was to determine the relationship between the serum concentration of chlorides of the donor and the onset of the function of the kidney allograft in the recipient. METHODS: We retrospectively studied 213 donors and kidney allograft recipients. Serum creatinine concentrations and glomerular filtration rates on the 1st, 7th, and 30th days after transplantation of the recipients from hyperchloremic donors were compared with the recipients from normochloremic donors, as well as the incidences of acute tubular necrosis and delayed graft function. RESULTS: On the 1st day, serum creatinine concentrations of the recipients from hyperchloremic and normochloremic donors, respectively, were 448.2 ± 212.1 μmol/L and 502.2 ± 197.8 μmol/L (P = .1), on the 7th day, 168.6 ± 102.6 μmol/L and 196.9 ± 120.6 μmol/L (P = .13), and on the 30th day, 129.4 ± 43.3 μmol/L and 131.8 ± 43.6 μmol/L (P = .73). The differences were statistically significant. The groups also did not differ significantly in glomerular filtration rates and incidences of acute tubular necrosis and delayed graft function. CONCLUSIONS: In this study, no significant correlation between serum chloride concentrations of the organ donors and the onset of the function of kidney allografts in the recipients was found.

• MeSH
• Acidosis complications   physiopathology   MeSH
• Kidney Tubular Necrosis, Acute blood   epidemiology   etiology   MeSH
• Allografts physiopathology   MeSH
• Chlorides blood   physiology   MeSH
• Tissue Donors * MeSH
• Adult MeSH
• Glomerular Filtration Rate MeSH
• Incidence MeSH
• Creatinine blood   MeSH
• Kidney physiopathology   MeSH
• Humans MeSH
• Brain Death physiopathology   MeSH
• Delayed Graft Function blood   epidemiology   etiology   MeSH
• Postoperative Complications blood   epidemiology   etiology   MeSH
• Retrospective Studies MeSH
• Kidney Transplantation * MeSH
• Kidney Function Tests MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Chlorides MeSH
• Creatinine MeSH