[Metformin-associated lactic acidosis]

Area of Science:

• Internal Medicine
• Nephrology
• Toxicology

Background:

• Metformin accumulation is a known cause of lactic acidosis and hemodynamic instability.
• Patients with diabetes, renal failure, and hypertension are at increased risk.

Observation:

• A case of a diabetic patient with renal failure and hypertension presented with severe acidosis, lactataemia, bradycardia, and hypotension.
• Despite dialysis and high-dose vasopressor therapy, the patient remained hemodynamically unstable.
• Administration of methylene blue resulted in rapid hemodynamic stabilization.

Findings:

• Methylene blue effectively reversed the refractory hypotension and hemodynamic instability.
• The patient recovered fully after treatment with methylene blue and dialysis.

Implications:

• Methylene blue may be a valuable adjunct to dialysis in managing metformin-induced lactic acidosis and associated hemodynamic compromise.
• This case highlights a potential therapeutic option for patients with metformin toxicity unresponsive to conventional treatments.