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Case Reports
. 2024 May 20;16(5):e60661.
doi: 10.7759/cureus.60661. eCollection 2024 May.

Euglycemic Ketoacidosis and Lactic Acidosis Associated With Metformin Toxicity

Feras Al-Moussally  1 , Jung-Jung Tien  2 , Kanya Rajagopalan  2 , Carlos Boterosuarez  2 , Roger Crouse  3
Affiliations
Case Reports

Euglycemic Ketoacidosis and Lactic Acidosis Associated With Metformin Toxicity

Feras Al-Moussally et al. Cureus. .

Abstract

In patients with diabetes, diabetic ketoacidosis (DKA) is a well-documented potential complication, usually presenting with hyperglycemia, anion gap acidosis, and positive ketones. Metformin toxicity in the setting of acute renal failure is also a well-known cause of lactic acidosis. However, metformin-induced euglycemic ketoacidosis is less well-known or studied. We report a case of metformin toxicity in the setting of acute renal failure with both lactic acidosis and ketosis and an initial confounded clinical presentation of sulphonylurea-induced hypoglycemia. A high index of suspicion for metformin-associated lactic acidosis (MALA) and metformin-associated lactic acidosis with euglycemic ketoacidosis (MALKA) should be in place in patients who are taking metformin and presenting with acute renal failure and euglycemia.

Keywords: diabetes; diabetes type 2; euglycemia; hypoglycemia; mellitus; metformin.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

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Figure 1. CT head
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Figure 2. CT cervical spine
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References

    1. Combined metformin-associated lactic acidosis and euglycemic ketoacidosis. Schwetz V, Eisner F, Schilcher G, et al. Wien Klin Wochenschr. 2017;129:646–649. - PMC - PubMed
    1. Metformin associated lactic acidosis and euglycemic diabetic ketoacidosis: a case report. Hasnie U, Shen J, Hasnie A, Tolwani A. SN Comprehensive Clin Med. 2021;3:698–700.
    1. Metformin in 2019. Flory J, Lipska K. JAMA. 2019;321:1926–1927. - PMC - PubMed
    1. Metformin-associated lactic acidosis: current perspectives on causes and risk. DeFronzo R, Fleming GA, Chen K, Bicsak TA. Metabolism. 2016;65:20–29. - PubMed
    1. A study of associations between plasma metformin concentration, lactic acidosis, and mortality in an emergency hospitalization context. Bennis Y, Bodeau S, Batteux B, et al. Crit Care Med. 2020;48:0–202. - PubMed

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