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Feeling blue with metformin-associated lactic acidosis
Benjamin Plumb1, Alex Parker, Paul Wong
1Postgraduate Medical Education, North Bristol NHS Trust, Bristol, UK. benjamin.plumb@nbt.nhs.uk
BMJ Case Reports
|March 5, 2013
Summary
A diabetic patient with metformin toxicity and lactic acidosis experienced cardiac arrest but was resuscitated. Methylene blue infusion led to a rapid recovery, highlighting its potential in managing severe cases.
Area of Science:
- Nephrology
- Toxicology
- Cardiology
Background:
- Metformin toxicity can cause severe lactic acidosis and hemodynamic instability.
- Acute kidney injury (AKI) and shock are serious complications in patients with metformin overdose.
- Concomitant use of ACE inhibitors may exacerbate metformin-related complications.
Observation:
- A 66-year-old diabetic woman presented with vomiting, abdominal pain, refractory shock, and AKI.
- She developed pulseless electrical activity (PEA) cardiac arrest with severe lactic acidosis (pH 6.57).
- Despite intensive treatment including haemodiafiltration, she remained hemodynamically unstable.
Findings:
- Successful resuscitation from PEA cardiac arrest was achieved despite profound acidosis.
- Methylene blue infusion was introduced as a potential therapeutic intervention.
- The patient experienced a full and rapid recovery following the methylene blue infusion.
Implications:
- Methylene blue may be a life-saving treatment for refractory shock and severe lactic acidosis due to metformin toxicity.
- This case underscores the critical importance of early recognition and aggressive management of metformin-induced complications.
- Further research into the role of methylene blue in managing toxicological emergencies is warranted.
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