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Case Reports
. 2021 Jul 8;14(7):e239154.
doi: 10.1136/bcr-2020-239154.

Metformin-associated lactic acidosis

Emma Jane Fadden  1 , Christian Longley  2 , Tushar Mahambrey  2
Affiliations
Case Reports

Metformin-associated lactic acidosis

Emma Jane Fadden et al. BMJ Case Rep. .

Abstract

A 58-year-old female with known type 2 diabetes mellitus continued to take her usual medications, including metformin, an ACE inhibitor and a non-steroidal anti-inflammatory drug, while suffering from diarrhoea and vomiting. On presentation to the emergency department, she was found to have a profound lactic acidosis, cardiovascular instability and acute kidney injury. Despite a pH of 6.6, lactate of 14 mmol/L and a brief asystolic cardiac arrest, supportive treatment and the use of renal replacement therapy resulted in rapid improvement in her acid-base abnormalities and haemodynamic parameters. Metformin-associated lactic acidosis is a rare but life-threatening complication of diabetes management. Patient education and awareness amongst clinicians are paramount in the prevention and treatment of this condition.

Keywords: adult intensive care; diabetes; dialysis; drugs: endocrine system; unwanted effects / adverse reactions.

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Conflict of interest statement

Competing interests: None declared.

References

    1. Salpeter SR, Greyber E, Pasternak GA. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev 2010;4. 10.1002/14651858.CD002967 - DOI - PMC - PubMed
    1. Lalau JD, Race JM. Lactic acidosis in metformin-treated patients. prognostic value of arterial lactate levels and plasma metformin concentrations. Drug Saf 1999;20:377. 10.2165/00002018-199920040-00006 - DOI - PubMed
    1. Seidowsky A, Nseir S, Houdret N, et al. . Metformin-associated lactic acidosis: a prognostic and therapeutic study. Crit Care Med 2009;37:2191–6. 10.1097/CCM.0b013e3181a02490 - DOI - PubMed
    1. Dell'Aglio DM, Perino LJ, Kazzi Z, et al. . Acute metformin overdose: examining serum pH, lactate level, and metformin concentrations in survivors versus nonsurvivors: a systematic review of the literature. Ann Emerg Med 2009;54:818–23. 10.1016/j.annemergmed.2009.04.023 - DOI - PubMed

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