Nursing Care in Patient Metformin Associated Lactic Acidosis Received Hemodialysis: 2 Case study

Abstract

Background : Although Metformin has become a drug of choice for the treatment of type 2 diabetes mellitus, a serious condition called metformin associated lactic acidosis (MALA). The incidence of lactic acidosis in patients on metformin therapy appears to be very low, but it can be fetal when it occurs. Especially in patients leading to Acute Kidney Injury with Shock or/and Respiratory Failure.  But found that treatment using hemodialysis can result in a favorable outcome.

Objective: To comparison nursing diagnosis, nursing action plan, evaluation outcome of nursing and development the nursing protocol for metformin associated lactic acidosis (MALA) Received Hemodialysis.

 Methods : This study was 2 cases study by purposive sampling from metformin associated lactic acidosis (MALA) who were received hemodialysis treatment at Mahasarakham Hospital. The data were collected from medical records, nursing protocol, patients and their relative. The nursing protocols were followed guideline self-evaluation 11 role of Gordon. The nursing action plan followed nursing diagnosis, conclusion and evaluated the outcome of nursing care.

Result : The case 1 was male, age 31 years, has been diagnosis for type 2 diabetes mellitus with hypertension 5 years follow up in Kosumphisai hospital never lack of medicine. On MFM (500 mg) 2x2 po pc. GPZ 2x2 po pc. Patient has diarrhea 5-6 time per day and frequent nausea vomiting come on 3 day. Find metformin associated lactic acidosis (MALA) received hemodialysis treatment 6 time. Intra hemodialysis patient has complication but can safe clinical and risk complication. The totally he admit 12 days. The case 2 was female, age 44 years, has been diagnosis for type 2 diabetes mellitus 3 years regular follow up in Gaedam hospital never lack of medicine. On MFM (500 mg) 2x2 po pc. One day ago patient has diarrhea 12 time and vomiting 10 time. First time patient Shock with metformin associated lactic acidosis (MALA) treatment using drug and hemodialysis 2 time. On time hemodialysis patient no complication. The totally he admit 6 days.                 

Conclusion : The urgent evaluation of metformin associated lactic acidosis (MALA) during hemodialysis and performance nursing care can reduces complication, severe and risk of mortality rate. The importantly nurse should have knowledge, specialization and have standard guideline for take care patients.