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Case report
Metformin-associated lactic acidosis: reinforcing learning points
  1. Mohummad Shaan Goonoo1,
  2. Rebecca Morris2,
  3. Ajay Raithatha2 and
  4. Fionuala Creagh1
  1. 1Diabetes and Endocrine Centre, Hadfield Wing, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  2. 2Critical Care Department, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  1. Correspondence to Dr Mohummad Shaan Goonoo; mshaan.goonoo{at}doctors.org.uk

Abstract

Metformin-associated lactic acidosis (MALA) carries a high mortality rate. It is seen in patients with type 2 diabetes on metformin or patients who attempt suicide with metformin overdose. We present the case of a man in his early 20s with type 2 diabetes, hypertension and hypothyroidism who presented with agitation, abdominal pain and vomiting after ingesting 50–60 g of metformin; he developed severe lactic acidosis (blood pH 6.93, bicarbonate 7.8 mEq/L, lactate 28.0 mEq/L). He was managed with intravenous 8.4% bicarbonate infusion and continuous venovenous haemodiafiltration. He also developed acute renal failure (ARF) requiring intermittent haemodialysis and continuous haemodiafiltration. MALA is uncommon and causes changes in different vital organs and even death. The primary goals of therapy are restoration of acid-base status and removal of metformin. Early renal replacement therapy for ARF can result in rapid reversal of the acidosis and good recovery, even with levels of lactate normally considered to be incompatible with survival.

  • diabetes
  • intensive care
  • toxicology
  • fluid electrolyte and acid-base disturbances
  • renal intervention
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Footnotes

  • Contributors MSG: substantial contributions to conception and design, acquisition of data, drafting the article, revising it critically for important intellectual content, final approval of the version to be published. RM: substantial contributions to conception and design, drafting the article, revising it critically for important intellectual content, final approval of the version to be published. AR: substantial contributions to conception and design, revising it critically for important intellectual content, final approval of the version to be published. FC: substantial contributions to conception and design, revising it critically for important intellectual content, final approval of the version to be published.

  • 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 for publication Obtained.

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

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