Abstract: TH-PO1104

Metformin-Associated Lactic Acidosis in a Patient with Normal Renal Function

Session Information

Category: Fluid, Electrolytes, and Acid-Base

  • 704 Fluid, Electrolyte, Acid-Base Disorders

Authors

  • Mohiuddin, Naushaba, Henry Ford Hospital, Detroit, Michigan, United States
  • Li, Jian, None, Detroit, Michigan, United States
Background

INTRODUCTION Metformin -associated lactic acidosis (MALA) in patients without renal impairment is an infrequent serious complication .In patients in whom development of renal dysfunction is anticipated, monitoring renal function more frequently and discontinuing Metformin at early renal impairment is crucial. We present a case of severe lactic acidosis in a patient who had no contraindication to Metformin prescription.

Methods

Case: Patient is a 58 year old female presented with abdominal pain and diarrhea. She has history of Diabetes, HTN, with prior normal renal function on Metformin, Lisinopril and Lasix. In Emergency department patient was hypotensive .She was started on Vasopressors and given IV fluids. ABGs showed severe high an ion gap acidosis, acute renal failure and Lactate level of 11. Despite aggressive IV hydration, her Lactate trended up to 17.Braod spectrum antibiotics started. She was admitted to ICU. Acute abdomen, septic and cardiogenic shock were ruled out.On further review , was noted , patient was admitted at outside hospital 3 weeks ago ,with diarrhea, had negative work up .At that time she had CT abdomen with IV contrast. Metformin was held prior and 4 days after .Metformin was resumed on discharge. A week later, she had CTA of abdomen. Baseline creatinine was around 0.7mg/dl and GFR 88ml/min/1.73m2 .
Patient was started on sustained low-efficiency dialysis with regional citrate anticoagulation (SLED RCA), for MALA. A progressive recovery was observed, with initially weaning off pressors, lactate level improving and later complete recovery of her renal function.

Conclusion

Conclusion: 1. Identifying patients who are on metformin, at risk to develop Prerenal azotemia, or alteration in renal function can potentially prevent this life threatening condition.2. Presence of elevated lactic acidosis in a diabetic patient on metformin, even with baseline normal renal function, should trigger to consider MALA.