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Metformin-Associated Lactic Acidosis: A Case Report.

Takehide Umeda1, Taro Minami2, Keith Bartolomei2

  • 1Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, 420 Delaware Street SE, MMC 276, Minneapolis, MN, 55455, USA. umeda006@umn.edu.

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Metformin, a common diabetes drug, can cause severe lactic acidosis, a dangerous buildup of acid in the body. This case highlights the critical need for vigilant monitoring of patients on metformin, especially those with underlying health conditions.

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Area of Science:

  • Pharmacology
  • Nephrology
  • Critical Care Medicine

Background:

  • Metformin is a widely prescribed oral antihyperglycemic agent for type 2 diabetes mellitus.
  • Lactic acidosis is a rare but life-threatening adverse effect associated with metformin therapy.
  • Co-morbidities such as hypertension and peripheral vascular disease may increase the risk of metformin-induced lactic acidosis.

Purpose of the Study:

  • To report a case of life-threatening lactic acidosis in a patient with type 2 diabetes mellitus treated with metformin.
  • To emphasize the importance of recognizing and managing metformin-associated lactic acidosis.
  • To highlight the potential severity of this adverse drug reaction.

Main Methods:

  • A case report of a 54-year-old woman with type 2 diabetes, hypertension, and peripheral vascular disease who developed severe lactic acidosis.
  • Clinical presentation, laboratory findings, and treatment interventions including discontinuation of metformin and initiation of renal replacement therapy.
  • Naranjo assessment score used to evaluate the probability of the adverse drug reaction.

Main Results:

  • The patient presented with severe lactic acidosis (pH 6.57, lactate 16.3 mmol/L) and shock.
  • Despite aggressive management, severe acidemia persisted, necessitating renal replacement therapy.
  • Serum metformin concentration was significantly elevated at 42 mcg/mL.
  • The patient recovered without neurological complications after multiple dialysis treatments.

Conclusions:

  • Metformin can precipitate life-threatening lactic acidosis, particularly in patients with risk factors.
  • Prompt recognition, discontinuation of metformin, and supportive care, including renal replacement therapy, are crucial for management.
  • This case underscores the importance of considering metformin toxicity in patients with unexplained severe metabolic acidosis.