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Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus

Metformin, a medication used to lower glucose levels in patients with diabetes mellitus, has long been thought to increase the risk for a metabolic disorder known as lactic acidosis. This review summarised data from all known comparative and observational studies lasting at least one month, and found no cases of fatal or nonfatal lactic acidosis in 70,490 patient‐years of metformin use, or in 55,451 patient‐years for those not on metformin. Average lactate levels measured during metformin treatment were no different than for placebo or for other medications used to treat diabetes. In summary, there is no evidence at present that metformin is associated with an increased risk for lactic acidosis when prescribed under the study conditions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

There is limited evidence from three small trials suggesting that the correction of metabolic acidosis trials may have some beneficial effects on both protein and bone metabolism

In health, protein and amino acids remain in equilibrium however in CKD this balance is disturbed. Metabolic acidosis has been shown to have deleterious effects on protein balance, leading to a negative nitrogen balance, increased protein degradation, increased essential amino acid oxidation, reduced albumin synthesis and a lack of adaption to a low protein diet, and hence is associated with protein energy malnutrition, loss of lean body mass and muscle weakness. Metabolic acidosis is also a factor in the development of renal bone disease, as bone acts as a buffer for excess acid, with loss of mineral resulting from the increase in acid. This review found three small trials in adult haemodialysis patients (n = 117). The evidence for the benefits and risks of correcting metabolic acidosis is very limited with no RCTs in pre‐ESRD patients and none in children. These trials suggest there may be some beneficial effects on both protein and bone metabolism but the trials were underpowered to provide strong evidence.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Base administration or fluid bolus for preventing morbidity and mortality in preterm infants with metabolic acidosis

Sick preterm infants are easily affected by reduced oxygen levels, cold and poor blood circulation. Their blood becomes acid with a build up of lactic acid (metabolic acidosis) that their kidneys cannot correct. Metabolic acidosis in preterm infants may cause bleeding in the brain (intra or periventricular haemorrhage) and problems with longer‐term neurodevelopment (including hearing, vision and cognitive ability). Solutions of the alkaline sodium bicarbonate or tris‐(hydroxymethyl) amino methane (THAM) can be given to correct the acidity. These solutions are more concentrated than blood (hyperosmolar), which can change blood flow and cause bleeding in the brain, especially when given rapidly or in large quantities. The rationale for their use is to prevent the adverse outcomes that are associated with acidosis in preterm infants.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Is sodium bicarbonate therapy helpful for people with acute kidney problems?

Acute kidney damage is a common problem that is often found in people who need treatment for problems not related to kidney health. Failing kidney health often causes more acid than normal in the blood (acidosis), which in itself is thought to cause harm.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Rapid correction of early metabolic acidaemia in comparison with placebo, no intervention or slow correction in LBW infants

Plain language summary will be included with future update.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Surgery for unstable trauma patients

Trauma is one of the leading causes of death across all ages. Some patients with major abdominal trauma develop what is known as the 'lethal triad' ‐‐ impaired coagulation, metabolic acidosis, and hypothermia. This is a life‐threatening condition which significantly contributes to illness and death. To prevent this lethal triad, doctors need to control bleeding and prevent further heat loss.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Use of fetal scalp blood lactate for assessing fetal well‐being during labour

A fetal heart rate that is abnormal or not reassuring during labour may be caused by the inability of the baby to adapt to decreases in oxygen supply during the birth. Inadequate oxygen supply may lead to the development of acidosis (low pH levels) and increased lactate in the blood. After the amniotic membranes have ruptured and the cervix dilated to around 3 cm, it is possible to measure lactate (or pH) levels in a sample of blood taken from the baby's scalp. A much smaller amount of blood is needed for the lactate test than to measure pH. This review identified two studies of 3348 mother‐baby pairs that compared lactate and pH testing in labour. Lactate testing was more likely to be successful than pH testing, but with no differences in newborn outcomes, including the number of babies with low Apgar scores, low pH in their cord blood or admissions to the neonatal intensive care nursery. There were no differences in the number of mothers having caesarean sections, forceps or vacuum births between the two groups. We conclude that lactate testing in labour may be more likely to be successfully achieved than pH testing.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Medicines for Type 2 Diabetes: A Review of the Research for Adults

This summary covers the research on the benefits and possible side effects of medicines to lower or control your blood sugar. It will help you talk with your doctor or other health care professional to decide which medicines are best for you.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: June 30, 2011

Pregnancy and birth: How helpful is pulse oximetry screening for serious heart defects in newborns?

A newborn baby’s heart and pulse are routinely checked after birth. An additional screening test called pulse oximetry can help detect life-threatening heart defects in newborns earlier and more reliably.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 16, 2015

Medication for type 2 diabetes

People with type 2 diabetes have an increased risk of heart attacks and strokes. Depending on age and lifestyle, different medications and treatment goals can be important. It also depends on whether people have any other health problems.Since high blood sugar levels (hypoglycemia) are the main sign of type 2 diabetes, it seems logical to use blood-sugar lowering medication. But that is not always necessary. Medication is only needed if blood sugar levels cannot be regulated any other way, for example by changing your diet, losing weight or exercising more.Blood sugar levels that are permanently high can cause damage to the retina or the kidneys, and can also harm the blood vessels. The risk of stroke or heart attack may also increase. But the age at which type 2 diabetes begins also plays a role. Many older people with type 2 diabetes do not have any problems caused by an increased blood sugar level. For them, other conditions like high blood pressure are more serious.But if you are diagnosed with type 2 diabetes in your forties, you will probably live with the condition for quite a long time. Complications can occur even if your blood sugar levels are only slightly too high over a long period of time. It is therefore very important for younger people with diabetes to keep their blood sugar levels low.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 4, 2014

Carbonic anhydrase inhibitors for hypercapnic ventilatory failure in chronic obstructive pulmonary disease

Some people with advanced chronic lung disease (COPD ‐ chronic bronchitis or emphysema) can experience breathing failure. This involves chemical changes which in turn can lower the drive to breathe. The drug acetazolamide is used for mountain sickness, and it can stimulate breathing in some circumstances. The review of trials found that a few days of using acetazolamide can improve the level of oxygen in the blood of people with COPD. It is not clear if this leads to better outcomes, so more research is needed. Not enough data were reported on the safety of the drug.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants

Continuous positive airway pressure (CPAP) provides extra gas flow through the nose and thereby helps keep the lung properly inflated. This helps reduce breathing problems in preterm babies after the tube used to assist breathing is removed from their windpipe. Preterm babies (babies born before 37 weeks) may need help to breathe properly. Sometimes this is given via a tube placed into the windpipe, through the mouth or nose, to give oxygen from a machine (mechanical ventilation). This method helps restore breathing but when the tube is removed (this process of removal is called extubation), breathing problems can occur. Nasal continuous positive airways pressure (NCPAP) provides extra gas flow through the nose and thereby helps keep the lung properly inflated. The review of trials found NCPAP is effective in preventing failure of extubation after a period of mechanical ventilation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Postnatal phenobarbital for the prevention of intraventricular haemorrhage in preterm infants

Large bleeds in the centre of the brain can cause disability or death in preterm babies. Unstable blood pressure and blood flow to the brain are believed to cause intraventricular haemorrhage (IVH) (bleeding into the fluid‐filled cavities of the brain (ventricles). The drug phenobarbital is believed to stabilise blood pressure and, therefore, potentially help prevent IVH. The review of trials found that there was not enough evidence that postnatal phenobarbital is effective in preventing IVH. Furthermore, phenobarbital suppresses breathing in infants who are breathing spontaneously, causing a need for mechanical ventilation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Early versus late administration of amino acids in preterm infants receiving parenteral nutrition

Early administration of amino acids results in positive nitrogen balance. Metabolic acidosis, elevated serum ammonia and hypoglycaemia are not a complication of early administration of amino acids. Elevated blood urea nitrogen (BUN) is consistently associated with early administration of amino acids. We included seven trials in this review. The number of study participants is small and the protocols of the studies included are not identical.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Quick versus standard vaginal birth when a baby is bottom‐down

The best outcomes in childbirth for both mothers and babies are when babies are born head‐first. If the baby is in another position, there is a higher risk of complications including the need for caesarean section. In a ‘breech presentation’ the unborn baby is bottom‐down instead of head‐down. This review looked for evidence about whether a quicker birth might be better in such cases.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Buffered versus non‐buffered fluids given to adults during surgery

During surgery, patients are given fluids into their veins to prevent and treat dehydration and loss of blood. Some fluids consist of a simple salt solution whilst others are matched more closely to the fluid in the blood. These latter fluids are called buffered fluids because they maintain the balance of the acids and bases in the body. We searched the available literature for prospective randomized studies which compared outcomes with the use of buffered fluids and the use of non‐buffered fluids when given to patients during surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Antiviral treatment for chronic hepatitis C in patients with HIV infection

End‐stage liver disease due to chronic hepatitis C is the leading cause of death among patients with stable HIV. The recommended treatment for chronic hepatitis C among patients without HIV is peginterferon plus ribavirin. Based on evidence from trials on HIV‐negative patients with hepatitis C, the viral genotype, dose of treatment and duration of therapy may affect the treatment response. This review is the first to evaluate the antiviral effect of peginterferon, ribavirin or amantadine administered in different combinations for a patient group, which has not previously been treated for hepatitis C. A total of 14 randomised clinical trials with at total of 2269 patients have been included in this review.The present review suggests that peginterferon plus ribavirin may also be considered if patients have HIV. The dose of peginterferon was similar to that assessed in trials on patients without HIV (180 microgram or 1.5 microgram/kg once weekly), but the dose of ribavirin was somewhat lower in most trials (800 mg daily). There were considerable differences between the trials possibly related to the dose and duration of treatment or the proportion of patients with different hepatitis C virus genotypes. The benefit of treatment was seen when assessing the proportion of patients with a sustained loss of the hepatitis C virus from the blood and the proportion with improved liver biopsies. No significant differences were seen in clinical outcome measures, including mortality (1%, irrespective of treatment). There were several adverse events. Fatal lactic acidosis and liver failure occurred. Other adverse events included anaemia and flu‐like symptoms that occurred more frequently among patients receiving peginterferon plus ribavirin. No significant differences were seen regarding the risk of depression, mortality, and progression to cirrhosis or to AIDS. Additional randomised trials are necessary to assess the effect in HIV and HCV co‐infected patients of peginterferon plus ribavirin in relation to the duration of therapy, especially in patients with hepatitis C genotype 2 or 3. Additional trials comparing peginterferon plus ribavirin versus interferon plus ribavirin or peginterferon alone do not seem warranted.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Non‐invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease

Non‐invasive positive pressure ventilation (NPPV) used in patients with acute exacerbations of COPD substantially improves recovery. Invasive mechanical ventilation is undoubtedly a lifesaving procedure for patients with severe life threatening (respiratory failure) exacerbation of their COPD. However, this procedure is also associated with numerous adverse effects. NPPV that requires wearing a nasal or facial mask connected to a mechanical ventilator has been shown to be beneficial for such patients in reducing hospital deaths and also the number of patients going on to require tracheal intubation. NPPV has also been shown to reduce complications associated with treatment and length of hospital stay.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Techniques for preventing hypotension during spinal anaesthesia for caesarean section

The incidence of hypotension during spinal anaesthesia for caesarean section is reduced by administering intravenous fluids, the drugs ephedrine or phenylephrine, or by leg compression.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Normal saline versus lower‐chloride solutions for kidney transplantation

People with kidney failure may have a kidney transplant to replace the function of their own kidneys. During a kidney transplant operation, patients receive fluids through their veins to keep them hydrated. Maintaining good hydration helps the transplanted kidney to work after the operation. The choice of fluids that are given during and after the operation may have an effect on how the transplant kidney works after surgery and on the patient's acid‐base measures in the blood.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

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