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[Metformin-associated lactic acidosis precipitated by acute renal failure]
J P Pertek1, S Vidal, J Mariot
1Service d'anesthésie-réanimation, hôpital Saint-André, 4, rue Châtillon, 57045 cedex 1, Metz, France. jppertek@wanadoo.fr <jppertek@wanadoo.fr>
Annales Francaises D'Anesthesie Et De Reanimation
|July 2, 2003
Summary
Metformin can cause lactic acidosis in type II diabetes patients, especially with acute renal failure. Prompt lactate measurement and bicarbonate hemodialysis are crucial for managing metformin-induced lactic acidosis.
Area of Science:
- Endocrinology
- Nephrology
- Toxicology
Background:
- Metformin is a common treatment for type II diabetes.
- Lactic acidosis is a rare but serious complication of metformin therapy.
- Acute renal failure can precipitate metformin-induced lactic acidosis.
Observation:
- A 65-year-old woman with type II diabetes developed severe lactic acidosis due to metformin toxicity.
- Her condition was triggered by acute renal failure, caused by diuretics, NSAIDs, and colchicine.
- Initial treatments with fluid resuscitation and bicarbonate failed.
Findings:
- The patient presented with severe metabolic acidosis (pH 7.01), high anion gap (35 mmol/L), and elevated lactate (12.4 mmol/L).
- Retrospective toxicology revealed a metformin plasma concentration of 20 mg/L (normal <2 mg/L).
- Prolonged hemodialysis with bicarbonate dialysate led to a favorable outcome.
Implications:
- Metformin should be temporarily discontinued in patients with acute renal failure or when it is anticipated.
- Patients with acute renal failure and high anion gap should be monitored for lactate levels.
- Early bicarbonate hemodialysis is an effective treatment for metformin-induced lactic acidosis associated with acute renal failure.