Volume 25
Number 0
Jan 2017
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Case Reports
J.E. Schopman, C.S. Bouman, C.M. Canté, S. Kouwen, F. Holleman, N.P. Juffermans

A male patient was admitted to the intensive care unit with severe shock and lactic acidosis following an intentional metformin overdose and possible co-ingestion of nifedipine. Despite supportive care and prompt initiation of continuous venovenous haemofiltration (CVVH) with a replacement rate of 35 ml/kg/h, the patient’s medical condition, including shock and lactic acidosis, rapidly deteriorated. In order to further increase metformin and lactate clearance the patient was connected to a second CVVH device resulting in a total effluent rate of 7 l/h. In the following hours the patient stabilised, and plasma lactate levels steadily decreased. Within a few days, haemofiltration was stopped and the patient was discharged from the ICU. This case report highlights the feasibility of high-volume CVVH using a second CVVH machine as a rescue therapy in patients with severe lactic acidosis.

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