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Metformin toxicity leading to severe lactic acidosis: case report An 86-year-old woman developed metformin toxicity leading to severe lactic acidosis (LA) during treatment with metformin/ sitagliptin for diabetes. The woman had a history of hypertension and diabetes. She had been receiving metformin/sitagliptin [sitagliptin/metformin; route and dosage not stated] for diabetes. She presented to an emergency department (ED) with 5-day of vomiting, nausea and diarrhoea. Lactic acid and pH were noted to be 14.4 mmol/L and 7.012, respectively. In the ED, the woman was treated with insulin, calcium gluconate, glucose [dextrose] and sodium bicarbonate. After few hours, the pH was noted to have improved; however, the lactic acid level worsened to 22.0 mmol/L. Based on the presence of refractory LA and positive history of metformin use, she was diagnosed with metformin-induced severe LA [duration of treatment to reaction onset not stated]. She started receiving continuous venovenous-haemodialysis (CVV-HD) for refractory acidosis. Following 7 hours of CVV-HD, the lactic acid level was noted to have improved (11.3 mmol/L), and significant amount of urination was noted. The CVV-HD was discontinued, and the lactic acid level continued to improve. On day 2, the lactic acid level normalised, and she was discharged in a stable condition. Soni P, et al. A case of severe lactic acidosis due to metformin toxicity. American Journal of Respiratory and Critical Care Medicine 199: no pagination abstr. A4849, No. 9, 803446223 May 2019. Available from: URL: https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A4849 [abstract]

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Reactions 18 Jan 2020 No. 1787