Metformin associated lactic acidosis: A case report

U.K Jayasundara,S, Pirasath,F.R Riza,A.G.H Sugathapala

doi:10.4038/sjdem.v10i1.7390

Abstract

Metformin, together with lifestyle intervention, is considered first-line treatment for glycemic management in people with type 2 diabetes. Despite this widespread use, one of the areas of longstanding debate has been whether metformin can be used safely in those with chronic kidney disease (CKD). The concern is the possibility of an increased risk for lactic acidosis resulting from metformin accumulation in those with renal impairment. Metformin associated lactic acidosis (MALA) is a rare complication of long-term metformin therapy and the risk is increased in patients who have concomitant risk factors like cardiac, renal or liver failure. This condition is associated with high mortality and morbidity.

Highlights

Metformin is a dimethylbiguanide related oral hypoglycemic and is commonly prescribed to treat type 2 diabetes through actions of reducing the hepatic gluconeogenesis and increasing the sensitivity of peripheral tissues to insulin (1)
Lactic acidosis is a rare complication of metformin with an incidence of 3 to 47 per 100000 cases in literature and occurs with long term use of metformin in patients with concomitant risk factors like cardiac, renal or liver failure (2)
Metformin associated lactic acidosis (MALA) refers to a clinical scenario where lactic acidosis is seen in patients who are on long term metformin and have concomitant risk factors such as cardiac, renal or liver failure which may contribute to lactic acidosis (2)

Summary

Introduction

Metformin is a dimethylbiguanide related oral hypoglycemic and is commonly prescribed to treat type 2 diabetes through actions of reducing the hepatic gluconeogenesis and increasing the sensitivity of peripheral tissues to insulin (1). There was no evidence of respiratory tract, urinary tract or skin sepsis She was a known patient with diabetes and dyslipidaemia, for which she was on metformin 1g thrice daily and atorvastatin 20 mg daily for one year. She was found to have stage 3b chronic kidney disease with an estimated glomerular filtration rate (eGFR) of 40 ml/kg/1.73m2. There was evidence of severe high anion gap metabolic acidosis with a pH of 6.9, bicarbonate 2.4 mmol/L, lactate 11.2 mmol/L and base excess 26 in her arterial blood gas analysis. She expired four hours after admission despite vigorous resuscitation

Discussion

Conclusion