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Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro

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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.

|September 9, 2020

Summary

This summary is machine-generated.

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.

Keywords:

acidemia acidosis diabetes hemodialysis lactic acidosis metformin severe acidosis

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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.