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  • Surviving cardiac arrest from severe metformin-associated lactic acidosis using extracorporeal membrane oxygenation and double continuous venovenous haemodialysis

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Case Reports: Reminder of important clinical lesson
Surviving cardiac arrest from severe metformin-associated lactic acidosis using extracorporeal membrane oxygenation and double continuous venovenous haemodialysis
  1. Kirstine Krushave Akkaoui1,
  2. Ljubica Vukelic Andersen2,
  3. Martin Agge Nørgaard3 and
  4. Jo Bønding Andreasen4
  1. 1 Anaesthesia and Intensive Care, Aalborg Universitetshospital, Aalborg, Denmark
  2. 2 Cardiology, Aalborg Universitetshospital, Aalborg, Denmark
  3. 3 Thoracic Surgery, Aalborg Universitetshospital, Aalborg, Denmark
  4. 4 Thoracic Intensive Care Unit, Aalborg Universitetshospital, Aalborg, Denmark
  1. Correspondence to Dr Jo Bønding Andreasen; jo.a{at}rn.dk

Abstract

Metformin-associated lactic acidosis (MALA) is a serious condition with high mortality. This case describes a man in the mid-60s with diabetes mellitus type 2 treated with metformin developing MALA 4 days after coronary stenting for non-ST-elevation myocardial infarction. He presented acutely with severe abdominal pain, a lactate of 19 mmol/L and pH 6.74. Despite treatment for MALA, he went into refractory cardiac arrest and was connected to venoarterial extracorporeal membrane oxygenation (VA-ECMO). He suffered a massive haemothorax due to perforation of the right atrial appendage. It was repaired through a sternotomy while being given massive blood transfusions. The following days, he was on VA-ECMO and double continuous venovenous haemodialysis (CVVHD). He survived with only mild paresis of the left hand. VA-ECMO should be considered a rescue therapy alongside treatment with CVVHD in case of cardiac arrest due to severe MALA.

  • Resuscitation
  • Adult intensive care
  • Dialysis
  • Cardiovascular medicine
  • Fluid electrolyte and acid-base disturbances

https://doi.org/10.1136/bcr-2023-254649

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    Footnotes

    • Contributors All authors were involved in treating the patient. KKA made the draft and revised it for submission. KKA also obtained consent from the patient. MAN revised the manuscript mainly as regards surgical matters. LVA revised the manuscript mainly as regards cardiology and toxicology. JBA revised and gave scientific input. All authors gave final approval of the submitted manuscript. They all agree to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved. All authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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