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[Metformin-induced lactic acidosis].

W Reeker1, G Schneider, N Felgenhauer

  • 1Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München. Wolfram.Reeker@lrz.tu-muenchen.de

Deutsche Medizinische Wochenschrift (1946)
|April 1, 2000
PubMed
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Metformin overdose in a diabetic patient with renal failure caused severe lactic acidosis. Continuous veno-venous hemodialysis effectively treated the condition, leading to a full recovery.

Area of Science:

  • Internal Medicine
  • Nephrology
  • Toxicology

Background:

  • Metformin is a common oral hypoglycemic agent for type 2 diabetes.
  • Renal impairment is a significant risk factor for metformin-associated lactic acidosis.
  • Patient presented with altered mental status and hemodynamic instability.

Observation:

  • A 62-year-old female diabetic on metformin and glimepiride with incipient renal failure presented with unconsciousness.
  • Physical examination revealed dilated pupils, cardiovascular instability, and severe hypothermia (28°C).
  • Laboratory tests showed marked lactic acidosis (lactate 45.3 mmol/l, pH 6.6) with negative toxicology screening.

Findings:

  • Metformin-induced lactic acidosis was confirmed as the cause of the patient's critical condition.

Related Experiment Videos

  • Conventional management failed to correct the acidosis or stabilize the patient.
  • Continuous veno-venous hemodialysis with bicarbonate-buffered solutions was initiated, leading to reduced catecholamine requirements.

    • Implications:

    • Metformin prescription requires careful monitoring of contraindications, especially renal function.
    • Early intervention with continuous veno-venous hemodialysis is crucial for managing severe lactic acidosis.
    • Hypothermia may have contributed to favorable neurological outcomes in this severe metformin toxicity case.