The Dramatic Recovery of a Patient with Biguanide-associated Severe Lactic Acidosis Following Thiamine Supplementation

Abstract

Biguanides are a drug of choice for the treatment of type 2 diabetes mellitus. Although they can cause lactic acidosis in susceptible patients with predisposing risk factors, the incidence of lactic acidosis is reported to be very low when they are used properly. We herein present a case of biguanide-associated severe lactic acidosis complicated with thiamine deficiency that was provoked without predisposing factors for thiamine deficiency. Diabetic patients taking biguanide may be predisposed to thiamine deficiency, even when there is no evidence of risk factors, and the high-dose administration of thiamine may be essential in the treatment of this otherwise under-recognized disorder.

Figure.

The clinical course of the patient’s hemodynamic status, circulatory management, and lactic acidosis. The patient’s marked lactic acidosis and the reduction in her left ventricular systolic function were dramatically reversed by the administration of high-dose thiamine. Each arrow indicates the intravenous administration of fursultiamine (100 mg), a thiamine derivative. CAs: denotes catecholamines, CRRT: continuous renal replacement therapy, IABP: intra-aortic balloon pump, LVEF: left ventricular ejection fraction, NaHCO₃: sodium bicarbonate, sBP: systolic blood pressure