ECE2022 Eposter Presentations Diabetes, Obesity, Metabolism and Nutrition (318 abstracts)
Double Trouble. Metformin and empagliflozin induced lactic acidosis - A case report
Bhavna Sharma , Michele Mantega , Mahesh Deore , Ian Seetho , Shivashankar Seechurn , Elaine Hui , Mushtaqur Rahman & Asjid Qureshi
Northwick Park Hospital, United Kingdom
63 years old with sarcoidosis since 2018 and type 2 diabetes was referred by GP for hypercalcemia related to likely dehydration and sarcoidosis. She was started on a weaning dose of prednisolone and empagliflozin. She had already been on metformin for several years. She was discharged after calcium improved from 2.97 mmol/l to 2.83 mmol/l. She was advised to follow up in Ambulatory care in 1 week for repeat calcium levels. On follow up, noted to have calcium levels of 2.67 mmol/l. Lactate noted to be 6.9 with a pH of 7.3 (calculated anion gap 13.1 mmol/l). Patient noted to be completely asymptomatic with normal systemic exam. Given fluids in ambulatory care, however, lactate noted to be rising at 7.7 with negative ketones and normal sugars. Empagliflozin was stopped and insulin was initiated with normalization of lactate with minimal fluid therapy. A literature review noted a similar case by Tomigana et al1 with lactic acidosis after initiation of empagliflozin along with metformin. Cellular dehydration with inhibition of enzymes may contribute to high lactate in the patients treated with metformin and an SGLT2 inhibitor. Lactate should be checked in unwell patients on metformin and an SGLT2 inhibitor. The effect of this complication on mortality/morbidity is unclear and further research is needed.
Reference: 1. Tominaga T, Ozaki M, Kanda M, Maeda R, Otuka H, Otake K, et al. A Case of Lactic Acidosis after Resumption of Metformin and SGLT2 Inhibitors. Ann Clin Case Rep. 2021; 6: 1924.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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