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Metformin-associated lactic acidosis precipitated by liraglutide use: adverse effects of aggressive antihyperglycaemic therapy
  1. Ananya Hooda1,
  2. Anurag Mehta2 and
  3. Franck Hannallah3
  1. 1 Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2 Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
  3. 3 Department of Internal Medicine, Pulmonary and Critical Care, University of Texas Southwestern, Dallas, Texas, USA
  1. Correspondence to Dr Franck Hannallah, franckhannallah{at}


Older patients with type 2 diabetes are prone to developing adverse events with aggressive antihyperglycaemic therapy. Metformin-associated lactic acidosis (MALA) is one such rare, life-threatening adverse drug effect. We report the case of a 70-year-old man with a glycated haemoglobin of 7.9% who was on a stable, maximally tolerated dose of metformin for managing his type 2 diabetes. He was initiated on liraglutide injections with hopes to achieve better glycaemic control, but developed unrelenting nausea and vomiting during the third week of treatment. He presented to the hospital with these symptoms and was noted to have severe MALA. He sustained an in-hospital cardiac arrest requiring emergent resuscitation along with vasopressor and mechanical ventilator support. He underwent continuous venovenous haemodiafiltration to remove metformin and correct the acidosis, following which he stabilised and supportive therapy was weaned off. He was discharged from the hospital on insulin therapy with incomplete renal recovery.

  • diabetes
  • drugs: endocrine system
  • unwanted effects / adverse reactions

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  • Contributors All authors made substantial contributions to conception and design of the work; gave final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AM and FH performed the acquisition, analysis and interpretation of data for the work and revised it critically for important intellectual content. AH drafted the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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