Hypoglycemia-Induced Basal Ganglia Infarct: A Rare Case of Metformin Toxicity in a Hemodialysis Patient

Metformin is the preferred agent in type 2 diabetes due to its efficacy, safety profile, cardioprotective benefits, weight loss, and accessibility in the market. However, Metformin should be prescribed with caution in patients with renal dysfunction and is contraindicated in those with a glomerular filtration rate (GFR) of less than 30 mL/min. Though extremely rare, accumulation of metformin due to poor renal clearance can cause metformin toxicity and subsequently cause lactic acidosis and hypoglycemia. The incidence is estimated at less than 10 events per 100,000 patients. Hypoglycemia has been shown to induce ischemic strokes in previous case reports; however, only one other case control study has shown hypoglycemia-induced strokes in the setting of metformin toxicity. Herein, we present a rare case of hypoglycemia-induced ischemic stroke from metformin toxicity, in a patient undergoing maintenance hemodialysis. Our case report illustrates an extremely rare case of metformin toxicity that caused a hypoglycemic-induced ischemic infarct.