Lactic acidosis secondary to metformin toxicity :a case report
Abstract
Lactic acidosis secondary to metformin toxicity: case report An 82-year-old man developed lactic acidosis secondary to metformin toxicity. The man was receiving therapy with metformin [route and dosage not stated] for non-insulin dependent diabetes mellitus. He subsequently presented with severe acidosis, respiratory failure requiring mechanical ventilation, profound shock and renal failure. Prior to the presentation, he visited to an outside hospital with nausea and vomiting and was found to be hypotensive; he rapidly declined into shock with severe lactic acidosis. His pH was 6.5 with a lactate level of 28 mmol/L prior to transfer. Following presentation, a continuous renal replacement therapy (CRRT) was started, with hyperventilatory compensation for metabolic acidosis. Test revealed the following: leukocytosis with a bandemia, lactate 28.6 mmol/L, glucose 16 mg/dL and bicarbonate 7 mEq/L. A metformin blood level was sent for analysis. His pH was corrected from an initial value of 6.98 to 7.43 over a period of 24 hours. His lactate level began to decline, normalising on hospital day 5. He was weaned from sedation on hospital day 3 and ultimately began following commands on hospital day 8. He was extubated on hospital day 9. He remained on CRRT, and his urine output increased to 280 mL/day by hospital day 10. On hospital day 11, his metformin analysis report returned with a value of 11 mcg/mL, suggesting his initial presentation was secondary to metformin toxicity. The…
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