Metformin-associated Lactic Acidosis Successfully Treated with Continuous Renal Replacement Therapy

Area of Science:

• Nephrology
• Critical Care Medicine
• Endocrinology

Background:

• Metformin-associated lactic acidosis (MALA) is a life-threatening condition linked to metformin use, particularly with risk factors like kidney dysfunction or poor blood flow.
• Septic shock can precipitate MALA, especially in patients with pre-existing conditions such as diabetes mellitus and recurrent urinary tract infections.

Observation:

• A 51-year-old female with type 2 diabetes presented with confusion and abdominal pain, progressing to septic shock and severe metabolic acidosis.
• Despite aggressive management including fluids, vasopressors, and bicarbonate, the patient's condition worsened, with deteriorating kidney function and persistent acidosis.
• A diagnosis of MALA was suspected due to the severity of acidosis disproportionate to vasopressor requirements.

Findings:

• Initiation of continuous renal replacement therapy (CRRT) led to a significant improvement in metabolic acidosis within 24 hours.
• Following CRRT, the patient's hemodynamic status stabilized, allowing for discontinuation of vasopressors, extubation, and de-escalation of antibiotics.

Implications:

• CRRT is a highly effective treatment for metformin-associated lactic acidosis, especially in critically ill patients with hemodynamic instability.
• Early consideration of CRRT in MALA cases can lead to favorable outcomes and rapid patient recovery.