Metformin-related lactic acidosis: Case report

  • Jesus Salvador Sanchez-Díaz Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Intensive Care Department, Veracruz, Mexico
  • Enrique Monares-Zepeda Hospital San Angel Inn Universidad, Mexico City, Mexico
  • Enrique Antonio Martinez-Rodríguez Medical School, Universidad Veracruzana, Veracruz Campus, Veracruz, Mexico
  • Jorge Samuel Cortes-Román Hospital Zambrano Hellion, Tec de Monterrey, Monterrey, Mexico
  • Oscar Torres-Aguilar Intensive Care Department, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
  • Karla Gabriela Peniche-Moguel Intensive Care Department, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
  • Susana Patricia Diaz-Gutierrez Intensive Care Department, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
  • Eusebio Pin-Gutierrez Intensive Care Department, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
  • Gerardo Rivera-Solís Intensive Care Department, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
  • Rosalba Carolina García-Méndez Intensive Care Department, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
  • Juan Marcelo Huanca-Pacaje Intensive Care Department, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
  • Maria Veronica Calyeca-Sánchez Intensive Care Department, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz, Mexico
Keywords: Acidosis, lactic, Metformin, Sodium bicarbonate, Renal replacement therapy, Lactic acid

Abstract

Lactic acidosis is defined as the presence of pH <7.35, blood lactate >2.0 mmol/L and PaCO2 <42 mmHg. However, the definition of severe lactic acidosis is controversial. The primary cause of severe lactic acidosis is shock. Although rare, metformin-related lactic acidosis is associated with a mortality as high as 50%. The treatment for metabolic acidosis, including lactic acidosis, may be specific or general, using sodium bicarbonate, trihydroxyaminomethane, carbicarb or continuous haemodiafiltration. The successful treatment of lactic acidosis depends on the control of the aetiological source. Intermittent or continuous renal replacement therapy is perfectly justified, shock being the argument for deciding which modality to use. We report a case of a male patient presenting with metformin poisoning as a result of attempted suicide, who developed lactic acidosis and multiple organ failure. The critical success factor was treatment with continuous haemodiafiltration.

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How to Cite
1.
Sanchez-Díaz JS, Monares-Zepeda E, Martinez-Rodríguez EA, Cortes-Román JS, Torres-Aguilar O, Peniche-Moguel KG, Diaz-Gutierrez SP, Pin-Gutierrez E, Rivera-Solís G, García-Méndez RC, Huanca-Pacaje JM, Calyeca-Sánchez MV. Metformin-related lactic acidosis: Case report. Colomb. J. Anesthesiol. [Internet]. 2017Oct.1 [cited 2021Apr.22];45(4):353–359. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/576

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Published
2017-10-01
How to Cite
1.
Sanchez-Díaz JS, Monares-Zepeda E, Martinez-Rodríguez EA, Cortes-Román JS, Torres-Aguilar O, Peniche-Moguel KG, Diaz-Gutierrez SP, Pin-Gutierrez E, Rivera-Solís G, García-Méndez RC, Huanca-Pacaje JM, Calyeca-Sánchez MV. Metformin-related lactic acidosis: Case report. Colomb. J. Anesthesiol. [Internet]. 2017Oct.1 [cited 2021Apr.22];45(4):353–359. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/576
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Case Report / Case Series

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