Initiation of metformin in MELAS patient–a dangerous combination
Abstract
Dear Editor, Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is a genetic mitochondrial disease that presents with progressive myopathy, headaches, and recurrent seizures associated with encephalopathy and neurologic deficits in childhood [1]. MELAS is usually caused by a mutation affecting mitochondrial protein translation, with direct pathogenic mutations in nicotinamide adenine dinucleotide (NADH) dehydrogenase (complex I of the electron transport chain) recently emerging as an important cause [2–4]. Metformin also inhibits complex I of the electron transport chain. Here, we report a patient with MELAS who developed an exacerbation of her MELAS pathology recently after being started on metformin. A 30-year-old woman with MELAS presented to the emergency department (ED) with at least three episodes of seizure activity prior to arrival. Fingerstick glucose on arrival was 248mg/dL. The patient’s weight was 50 kg. There was no return to her baseline mental status between the seizures. In the ED, despite levetiracetam (60mg/kg IV) and lorazepam (4mg IV), she continued to seize and was intubated for airway protection and ultimately admitted to the intensive care unit (ICU) for status epilepticus. Her initial blood lactate in the ED was 12.2mmol/L. Computed tomography angiogram (CTA) and magnetic resonance imaging (MRI) were unremarkable. Lumbar puncture was only notable for an elevated cerebrospinal fluid lactate to 9.7mmol/L (reference range…
Read the paper
Related studies
- Metformin as an adjuvant in breast cancer treatment
- Metformin Lysosomal Targeting: A Novel Aspect to Be Investigated for Metformin Repurposing in Neurodegenerative Diseases?
- Aberrant HSF1 signaling activation underlies metformin amelioration of myocardial infarction in mice
- Metformin induces ZFP36 by mTORC1 inhibition in cervical cancer-derived cell lines
- Protein Interaction Network for Identifying Vascular Response of Metformin (Oral Antidiabetic)
- Preventing Long COVID With Metformin
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.