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Lactic acidosis secondary to metformin overdose: a case report

Timbrell, Simon; Wilbourn, Gary; Harper, James; Liddle, Alan

Authors

Simon Timbrell

Gary Wilbourn

James Harper

Alan Liddle



Abstract

Introduction
Metformin is a commonly used treatment modality in type 2 diabetes mellitus, with a well documented side effect of lactic acidosis. In the intensive care setting lactate and pH levels are regularly used as a useful predictor of poor prognosis. In this article we highlight how high lactate levels are not an accurate predictor of mortality in deliberate metformin overdose.

Case presentation
We present the case of a 70-year-old Caucasian man who took a deliberate metformin overdose of unknown quantity. He had a profound lactic acidosis at presentation with a pH of 6.93 and a lactate level of more than 20mmol/L. These figures would normally correspond with a mortality of more than 80%; however, with appropriate management this patient’s condition improved.

Conclusion
We provide evidence that the decision to treat severe lactic acidosis in deliberate metformin overdose should not be based on arterial lactate and pH levels, as would be the case in other overdoses. We also demonstrate that appropriate treatment with hemodiafiltration and 8.4% sodium bicarbonate, even in patients with a very high lactate and low pH, can be successful.

Journal Article Type Article
Publication Date Aug 2, 2012
Journal Journal of Medical Case Reports
Electronic ISSN 1752-1947
Publisher Humana Press
Peer Reviewed Peer Reviewed
Volume 6
Issue 230
Article Number 230
Institution Citation Timbrell, S., Wilbourn, G., Harper, J., & Liddle, A. (2012). Lactic acidosis secondary to metformin overdose: a case report. Journal of Medical Case Reports, 6(230), doi:10.1186/1752-1947-6-230
DOI https://doi.org/10.1186/1752-1947-6-230
Publisher URL http://www.jmedicalcasereports.com/content/6/1/230/abstract
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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