Metformin
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Various toxicities: case report A 52-year-old man developed vitamin-B12 deficiency, folate deficiency, pancytopenia and secondary myocardial infarction during treatment with metformin for type-2 diabetes [duration of treatment to reaction onsets not stated; not all outcomes stated]. The man, who had a history of type-2 diabetes, had been receiving metformin 2 550 mg/day [route not stated] for 10 years. He presented to a hospital with progressive chest pain and dyspnoea. A pale conjunctivae and glossitis were noted during physical examination. His serum troponin-T levels were increasing, and an ECG revealed ST-segment depression. A diagnosis of severe anaemia causing secondary myocardial infarction was made. His laboratory tests were as follows: WBC count 3 500 /mm3, mean corpuscular volume 128.3fL, platelet count 97 000 /mm3 and Hb 7.1 g/dL. A macrocytic anaemia was noted on peripheral blood smear test. He received red blood cells transfusion for severe anaemia. An ECG showed normal ST-segment. At the same time, a decrease in plasma vitamin-B12 and folate levels was noted with an elevated homocysteine level. These findings suggested metformin-induced vitamin-B12 and folate deficiency leading to pancytopenia. The man’s metformin therapy was stopped, and he was treated with folic acid [folate] and vitamin-B12. His haemoglobin and platelet count normalised and reticulocyte count increased after one week of the treatment. Unhapipatpong C, et al. Unusual manifestation of metformin-induced combined vitamin B12 and folate deficiency presenting with pancytopenia and secondary myocardial 803520232 infarction. Clinical Nutrition ESPEN 40: 624 abstr. LB-087, Dec 2020. Available from: URL: http://doi.org/10.1016/j.clnesp.2020.09.656 [abstract]
0114-9954/20/1834-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 12 Dec 2020 No. 1834
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