Metformin
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Lactic acidosis and transient vision loss: case report A 54-year-old man with insulin-dependent diabetes mellitus and chronic stage 1 kidney disease developed severe lactic acidosis and transient vision loss while receiving metformin. The man presented at an emergency department with metabolic acidosis, acute renal failure, severe hypoglycaemia, hyperventilation, and acute vision loss. He had experienced diarrhoea and vomiting 5 days earlier, and vision loss in the last 12 hours. His usual medications included metformin 850mg twice daily [route and duration of treatment not stated]. Physical examination revealed the following: Kussmaul respiratory pattern with 34 breaths/min; dry skin and mucous membranes; BP 70/52mm Hg; HR 101 beats/min; body temperature 36.8°C; and oxygen saturation 99% on room air. Slight confusion was evident on neurological assessment, and funduscope examination showed bilateral proliferative diabetic neuropathy with vitreous haemorrhage; visual acuity and fields were abnormal. The man’s treatment included crystalloids and sodium bicarbonate, but his metabolic and visual complaints persisted. In the ICU, conventional haemodialysis and circuit anticoagulation was performed. His lactate levels improved, spontaneous urine output was achieved at 150 cc/h, and his biochemical parameters improved markedly. He was discharged on day 12 with full recovery of his visual function and no neurological sequelae. His biochemical parameters were as follows: creatinine 1.98 mg/dL, blood urea nitrogen 28 mg/dL, sodium 135 mmol/L, pH 7.39, bicarbonate 24.3 mmol/L. Author comment: "Metformin therapy is a widely known cause of lactic acidosis, particularly when administered to patients with decreased renal function . . . [v]ision loss could be resulting from two factors, namely hypotension and superimposed metabolic acidosis". Cigarran S, et al. Transient vision loss in a patient with severe metforminassociated lactic acidosis. QJM - An International Journal of Medicine 105: 781-783, No. 8, Aug 2012. Available from: URL: http://dx.doi.org/10.1093/ 803078462 qjmed/hcr109 - Spain
0114-9954/10/1423-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 13 Oct 2012 No. 1423
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