Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 May-Jun;29(3):194-196.
doi: 10.4103/ijn.IJN_257_17.

Metformin-associated Encephalopathy in Hemodialysis

S P Simon  1 , J Thomas  1
Affiliations
Case Reports

Metformin-associated Encephalopathy in Hemodialysis

S P Simon et al. Indian J Nephrol. 2019 May-Jun.

Abstract

Metformin-associated encephalopathy in maintenance hemodialysis is very rare in literature, till now only three to four cases are published. We report a patient on maintenance hemodialysis from standalone unit presented to us with abnormal neurological signs and symptoms. His medication chart included metformin, which he was taking for quite a long time. Computed tomography brain showed hypointensity in bilateral basal ganglia. Magnetic resonance imaging (MRI) brain showed hyperintensity in T2/fluid-attenuated inversion recovery sequences suggestive of Lentiform fork sign. We stopped metformin, and he was continued on regular hemodialysis. He showed dramatic improvement in neurological manifestations. Two months later, we repeated MRI brain, which showed resolution of basal ganglia changes. We should suspect the possibility of this when a diabetic end-stage renal disease presents with unknown etiology of encephalopathy.

Keywords: Encephalopathy; Lentiform fork sign; end-stage renal disease; metformin.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Noncontrast computed tomography shows hypodensity in bilateral ganglia
Figure 2
Figure 2
Magnetic resonance imaging T2/fluid-attenuated inversion recovery with hyperintense basal ganglia
Figure 3
Figure 3
Magnetic resonance imaging T2/fluid-attenuated inversion recovery with resolution of changes in basal ganglia in repeat imaging 2 months later
Figure 4
Figure 4
Lentiform fork sign
See this image and copyright information in PMC

References

    1. Holstein A, Nahrwold D, Hinze S, Egberts EH. Contra-indications to metformin therapy are largely disregarded. Diabet Med. 1999;16:692–6. - PubMed
    1. American Diabetes Association. Standards of medical care in diabetes–2010. Diabetes Care. 2010;33(Suppl 1):S11–61. - PMC - PubMed
    1. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et al. Medical management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009;32:193–203. - PMC - PubMed
    1. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes: A patient-centered approach: Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) Diabetes Care. 2012;35:1364–79. - PMC - PubMed
    1. Mani MK. Metformin in renal failure – Weigh the evidence. Nephrol Dial Transplant. 2009;24:2287–8. - PubMed

Publication types