ECE2023 Eposter Presentations Diabetes, Obesity, Metabolism and Nutrition (355 abstracts)
Metformin-Associated Lactic Acidosis: A Case Report
Gökhan Baykal 1 , Mehdi Houssein 1 , İrem Önal 2 , Enes Seyda Şahiner 2 , Cemile Bicer 2 , Narin Nasiroglu Imga 1 , Oya Topaloglu 3 , Reyhan Ersoy 3 & Bekir Cakir 3
1Ankara Bilkent City Hospital, Endocrinology and Metabolism, Ankara, Turkey; 2Ankara Bilkent City Hospital, Internal Medicine, Ankara, Turkey; 3Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara Bilkent City Hospital, Endocrinology and Metabolism, Ankara, Turkey
Introduction: Metformin is widely used as the first-line therapy for patients with type 2 diabetes, and its most common adverse effects are gastrointestinal. Metformin-associated lactic acidosis (MALA) is a rare but serious adverse effect in patients with type 2 diabetes or patients who attempt suicide with metformin overdose. Here, we report the case of a 22-year-old woman who developed severe lactic acidosis after high-dose metformin was taken for a suicide attempt.
Case: A 22-year-old woman with anxiety disorder and depression developed life-threatening lactic acidosis after taking high doses of metformin to attempt suicide. The patient received approximately 30 g of metformin. She applied to the emergency department with slurred speech and nausea. In her initial laboratory findings, arterial blood gas pH was 7.41, bicarbonate 14 mmol/l, anion gap 13 mmol/l, lactate 7.5 mmol/l, and creatinine of 1.44 mg/dl. Then she deteriorated and arterial blood gas pH became 6.96, bicarbonate 5.8 mmol/l, anion gap 33 mmol/l, lactate 23.9 mmol/l, and creatinine of 1.99 mg/dl. Renal replacement therapy was initiated. After one dialysis session, her severe acidemia resolved over time. She was discharged from the hospital without any complications. A Naranjo assessment score of 9 was obtained, indicating a probable relationship between the patient’s lactic acidosis and her use of the suspect drug.
Conclusion: MALA is a well-known and life-threatening complication of metformin. Vomiting and diarrhea are the first signs of MALA. Even if severe lactic acidosis may not be apparent at first as in our case clinicians should be aware that lactic acidosis may develop. Severe lactic acidosis can be treated with renal replacement therapy because metformin is dialysable.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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