RT Journal Article
SR Electronic
T1 Metformin-associated lactic acidosis mimicking ischaemic bowel
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr-2017-221686
DO 10.1136/bcr-2017-221686
VO 2018
A1 Sajjad Ali
A1 Heloise Labuschagne
A1 Nickolay Azarov
A1 Zakaria Hindi
A1 Lavi Oud
YR 2018
UL http://casereports.bmj.com/content/2018/bcr-2017-221686.abstract
AB Metformin-associated lactic acidosis (MALA) is a rare complication among patients who are diabetic, commonly presenting with non-specific findings, and developing mostly among those with other risk factors for lactic acidosis. We report the development of MALA in a 67-year-old man with diabetes who presented with progressive abdominal pain and bloody diarrhoea. On presentation the patient was in shock, with signs suggestive of peritonitis, and with severe lactic acidosis, renal failure and non-specific findings on abdominal CT. Neither the patient nor family could provide details of his home pharmaceuticals. Circulatory resuscitation with intravenous crystalloids and vasopressors was commenced, along with empiric broad-spectrum antibiotics. Emergent laparotomy did not show pathological findings. Emergent haemodialysis, initiated postoperatively, resulted in rapid resolution of shock and lactic acidosis. A list of patient’s medications, provided afterwards by the family, included metformin. Microbiological studies remained negative and renal function normalised by the time of patient’s hospital discharge after 9 days.