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A Case Report on Metformin-Associated Lactic Acidosis
Harpreet K Rai1, Pranavkumar Patel1, Kalpana Reddy2
1Internal Medicine, Northwell Health Long Island Jewish Forest Hills Hospital, Forest Hills, USA.
Cureus
|September 9, 2020
Summary
Metformin-associated lactic acidosis is a rare but severe complication of type 2 diabetes treatment. This case highlights a fatal outcome in a patient with multiple comorbidities and acute kidney failure.
Area of Science:
- Endocrinology
- Nephrology
- Critical Care Medicine
Background:
- Metformin is a widely used first-line medication for type 2 diabetes.
- Gastrointestinal issues are common metformin side effects, while lactic acidosis is rare.
Observation:
- A 77-year-old male with diabetes, hypertension, alcohol abuse, and cancer presented with severe gastrointestinal symptoms.
- The patient developed acute kidney failure, sepsis, and severe metabolic acidosis due to metformin toxicity.
Findings:
- Metformin level was significantly elevated at 23 mcg/mL (therapeutic range: 1-2 mcg/mL).
- Despite intensive care including intubation, pressor support, and hemodialysis, the patient experienced multi-organ failure.
Implications:
- This case underscores the critical importance of monitoring metformin levels in patients with impaired renal function.
- Metformin-associated lactic acidosis can be fatal, especially in patients with comorbidities and acute kidney injury.
- Prompt recognition and management of metformin toxicity are crucial in critical care settings.
