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Metformin-associated respiratory alkalosis
Sean M Bryant1, Kirk Cumpston, Martin S Lipsky
1Division of Medical Toxicology and Hyperbaric Medicine, Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
American Journal of Therapeutics
|May 11, 2004
Summary
Metformin can cause respiratory alkalosis, an early sign of potential lactic acidosis, in elderly patients with diabetes. Discontinuing metformin quickly resolved symptoms in an 84-year-old man.
Area of Science:
- Internal Medicine
- Nephrology
- Endocrinology
Background:
- Metformin is a first-line oral hypoglycemic agent for type 2 diabetes.
- Metformin-associated lactic acidosis (MALA) is a rare but serious complication.
- Early identification of metformin adverse events is crucial for patient safety.
Observation:
- An 84-year-old male with multiple comorbidities presented with disorientation and confusion.
- The patient had recently started metformin therapy.
- Initial vital signs revealed hypertension, tachycardia, and Kussmaul respirations, with hyperglycemia.
Findings:
- Metformin was discontinued due to suspected adverse effects.
- The patient's vital signs and laboratory results normalized within 3 days.
- Respiratory alkalosis was identified as a potential early indicator of metformin toxicity.
Implications:
- This case highlights respiratory alkalosis as a possible early warning sign of metformin-induced complications.
- Clinicians should consider metformin adverse events in patients presenting with altered mental status and relevant risk factors.
- Prompt recognition and discontinuation of metformin can lead to rapid recovery and prevent severe outcomes like lactic acidosis.