Feeling blue with metformin-associated lactic acidosis
- 1Postgraduate Medical Education, North Bristol NHS Trust, Bristol, UK
- 2Department of Acute Medicine, Musgrove Park Hospital, Taunton, Somerset, UK
- 3Department Anaesthetics, Musgrove Park Hospital, Taunton, Somerset, UK
- Correspondence to Dr Benjamin Plumb, benjamin.plumb{at}nbt.nhs.uk
Summary
An active 66-year-old diabetic woman presented with a 5-day history of vomiting and abdominal pain, refractory shock and acute kidney injury (AKI). There was concomitant ACE inhibitor (ACEi) use and metformin toxicity with severe lactic acidosis. She suffered a pulseless electrical activity (PEA) cardiac arrest within 30 min of arrival to the Medical Admissions Unit. Despite a serum pH of 6.57 she was successfully resuscitated. She remained haemodynamically unstable even with fluid resuscitation, inotropic support and haemodiafiltration, yet made a full and rapid recovery following the introduction of a methylene blue infusion.
