Metformin-associated lactic acidosis in patients with CKD with control of metformin dosage based on renal function: A case report and review of literature
Abstract
Abstract A man in 50s with type 2 diabetes and stage 3a chronic kidney disease (CKD) developed metformin-associated lactic acidosis (MALA), even with control of metformin dosage based on renal function. He presented with vomiting, severe lactic acidosis, and acute kidney injury. Continuous hemodiafiltration (CHDF) was initiated after conservative therapy failed, resulting in rapid improvement of acidosis and renal recovery. The serum metformin concentration was in the toxic range, confirming MALA. After stopping CHDF, serum metformin concentration was not detected. This case highlights that MALA can occur even when metformin dosing is appropriately adjusted based on renal function in chronic kidney disease. Previous studies have suggested that metformin concentrations generally remain within the therapeutic range and lactate levels do not increase substantially when the dose is adjusted appropriately in patients with CKD. Therefore, metformin is considered relatively safe in this population. However, several reports have described MALA occurring despite dose adjustment according to renal function. Our review of literature showed several MALA cases with control of metformin dose based on the renal function in CKD patients. Therefore, clinicians should be aware that MALA can occur even when metformin dose was appropriately adjusted based on the renal function in CKD patients. In addition, discontinuation of metformin should be required with unexpected illness. Treatment with…
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