Abstract: SA-PO0333
From Health Food Store to the Intensive Care Unit (ICU): Berberine Supplementation-Induced Type B Lactic Acidosis
Session Information
- AKI: Case Reports - Drug/Toxin Injury, Crystals, Obstruction, and Unusual Presentations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Ekhator, Nehikhare, UC Davis Medical Center, Sacramento, California, United States
- Llamas, Marielle, UC Davis Medical Center, Sacramento, California, United States
- Wiegley, Nasim, UC Davis Medical Center, Sacramento, California, United States
Introduction
Over-the-counter supplements are widely perceived as safe; however, certain agents such as berberine may cause life-threatening metabolic complications, particularly in the setting of metabolic stress and impaired renal clearance. We present a case of severe lactic acidosis secondary to berberine use in the setting of kidney injury, necessitating dialysis for clearance.
Case Description
A 57-year-old Filipino man with insulin-dependent type 2 diabetes mellitus (no metformin or SLGT2i use) presented with lethargy, nausea, and vomiting. Laboratory testing revealed severe, high-anion-gap metabolic acidosis (AG 43) with arterial pH 7.14, bicarbonate 6 mmol/L, lactate >20 mmol/L, acute kidney injury (peak Cr 2.77 from a normal baseline), and hyperkalemia (6.5 mmol/L). Urinalysis showed trace ketonuria and numerous hyaline casts. Ethanol level was elevated (209 mg/dL), but toxic alcohol ingestion was excluded. Despite aggressive resuscitation with intravenous fluids, bicarbonate infusion, and resolution of ethanol intoxication, severe metabolic acidosis persisted. Toxicology evaluation identified chronic use of over-the-counter supplements, including berberine. Berberine can mimic metformin-associated lactic acidosis via inhibition of mitochondrial oxidative phosphorylation, promoting anaerobic glycolysis and lactate overproduction. Hemodialysis was initiated for rapid clearance of the supplement, resulting in normalization of metabolic parameters and sustained resolution of acidosis after discontinuation.
Discussion
This case illustrates severe type B lactic acidosis caused by berberine, a natural supplement. Berberine inhibits mitochondrial oxidative phosphorylation, mimicking metformin-associated toxicity (Figure 1). Reduced renal clearance can contribute to accumulation, resulting in severe acidemia. Differentiating this entity from alcoholic ketoacidosis and toxic ingestions is critical. Hemodialysis provided effective toxin clearance and rapidly corrected life-threatening metabolic derangements in this patient.