Abstract
Metformin is widely used in the treatment of type 2 diabetes, though it is recognized to be associated with the risk of lactic acidosis. A 61-year-old woman with type 2 diabetes under metformin therapy was admitted to our department with pronounced lactic acidosis (pH 6.60, lactate 17.5 mmol/l, base excess -30, standard bicarbonate 2.5 mmol/l, core body temperature 27.8°C). The patient presented with cardiac arrest and was successfully resuscitated. The severe metabolic acidosis was accompanied by acute renal failure and required repeated hemodialysis for correction during the intensive care treatment. There was no medical history of renal insufficiency. The patient showed a complete recovery including renal function with residually reduced mental capabilities as particularly the situative orientation was inconsistent. Furthermore, an explorative data analysis of our poison centre database from 1995 until 2003 concerning metformin was performed. In 109 inquiries for metformin a lactic acidosis (mean pH 6.87±0.11, mean lactate 20.9±8.1 mmol/l) was present in 14 cases (9 female, 5 male, average age 57.7 years) with 8 patients under regular metformin therapy and 6 patients who ingested large amounts of metformin to attempt suicide. 1 patient in the group with metformin treatment and 3 patients in the group with suicidal intoxication did not survive the severe metabolic disturbance. The present report demonstrates that metformin-associated lactic acidosis is a rare but critical complication of metformin therapy of type 2 diabetes as well as in acute suicidal ingestion of metformin. Early diagnosis and rapid correction of the metabolic acidosis using hemodialysis provides the possibility of a positive outcome even in severe cases. If metformin-associated lactic acidosis is suspected we recommend early involvement of a poison centre.
Published Version
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