Abstract
A 73-year-old man with diabetes presented with upper-abdominal pain and nausea. He also had a history of hypertension, a pace-maker implant, and peripheral arterial disease treated with amputation of his left leg. His therapy included ticlopidine, enalapril, omeprazole, and 2 mg glibenclamide/30 mg phenformin b.i.d. The patient was alert and cognitively intact. Blood pressure and heart rate were 120/70 mmHg and 70 bpm, respectively. Radiographs of the chest and abdomen and an abdominal ultrasound study were normal. Laboratory tests disclosed a severe lactic acidosis (pH 6.8, pCO2 14.1 mmHg, pO2 108 mmHg, HCO3 4.9 mmol/l, lactate 21 mmol/l, and …
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