Metformin-Associated Lactic Acidosis in a Diabetic Patient with Normal Kidney Function and Occult Cirrhosis
Background. Lactic acidosis is a well-known complication of metformin accumulation in diabetic patients with kidney failure. However, it is not usual to raise the diagnosis of metformin-associated lactic acidosis when patients have normal kidney function. The causes of metformin-induced high lactate...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Hindawi Limited
2022-01-01
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| Series: | Case Reports in Critical Care |
| Online Access: | http://dx.doi.org/10.1155/2022/5506744 |
| _version_ | 1827008328490811392 |
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| author | Jad Chidiac Rebecca Kassab Mirella Iskandar Sahar Koubar Mabel Aoun |
| author_facet | Jad Chidiac Rebecca Kassab Mirella Iskandar Sahar Koubar Mabel Aoun |
| author_sort | Jad Chidiac |
| collection | DOAJ |
| description | Background. Lactic acidosis is a well-known complication of metformin accumulation in diabetic patients with kidney failure. However, it is not usual to raise the diagnosis of metformin-associated lactic acidosis when patients have normal kidney function. The causes of metformin-induced high lactate include the accumulation of normal doses of metformin in chronic kidney disease, an overdose of this drug without kidney failure, or an increase in lactate production due to the inhibition of liver gluconeogenesis. Case Presentation. We report the case of a 61-year-old diabetic man who was brought to the emergency room in a comatose state. His family reported abdominal pain with diarrhea in the last two days. He was found to have severe lactic acidosis with normal serum creatinine. He was on a regular dose of metformin, and his family denied any other medical history or any alcohol abuse. He showed no signs of infection, his liver enzymes were slightly elevated, and he had severe anemia. His hemodynamics deteriorated quickly within hours, and an abdominal computed tomography scan revealed no abnormalities. He underwent a laparotomy that ruled out mesenteric ischemia and revealed an abnormal liver. The liver biopsy later confirmed the diagnosis of cirrhosis. Conclusions. We discuss here the probable causes of severe lactic acidosis and the role of metformin in exacerbating this acid-base disturbance in cirrhotic patients. Future research is needed to determine whether these patients might benefit from dialysis. |
| first_indexed | 2024-04-11T09:35:29Z |
| format | Article |
| id | doaj.art-4ac1c26ae4994a4b8122f87d77069bce |
| institution | Directory Open Access Journal |
| issn | 2090-6439 |
| language | English |
| last_indexed | 2025-02-18T12:31:07Z |
| publishDate | 2022-01-01 |
| publisher | Hindawi Limited |
| record_format | Article |
| series | Case Reports in Critical Care |
| spelling | doaj.art-4ac1c26ae4994a4b8122f87d77069bce2024-11-02T04:15:36ZengHindawi LimitedCase Reports in Critical Care2090-64392022-01-01202210.1155/2022/5506744Metformin-Associated Lactic Acidosis in a Diabetic Patient with Normal Kidney Function and Occult CirrhosisJad Chidiac0Rebecca Kassab1Mirella Iskandar2Sahar Koubar3Mabel Aoun4Holy Spirit University of KaslikFaculty of MedicineIntensive Care UnitNephrology DepartmentFaculty of MedicineBackground. Lactic acidosis is a well-known complication of metformin accumulation in diabetic patients with kidney failure. However, it is not usual to raise the diagnosis of metformin-associated lactic acidosis when patients have normal kidney function. The causes of metformin-induced high lactate include the accumulation of normal doses of metformin in chronic kidney disease, an overdose of this drug without kidney failure, or an increase in lactate production due to the inhibition of liver gluconeogenesis. Case Presentation. We report the case of a 61-year-old diabetic man who was brought to the emergency room in a comatose state. His family reported abdominal pain with diarrhea in the last two days. He was found to have severe lactic acidosis with normal serum creatinine. He was on a regular dose of metformin, and his family denied any other medical history or any alcohol abuse. He showed no signs of infection, his liver enzymes were slightly elevated, and he had severe anemia. His hemodynamics deteriorated quickly within hours, and an abdominal computed tomography scan revealed no abnormalities. He underwent a laparotomy that ruled out mesenteric ischemia and revealed an abnormal liver. The liver biopsy later confirmed the diagnosis of cirrhosis. Conclusions. We discuss here the probable causes of severe lactic acidosis and the role of metformin in exacerbating this acid-base disturbance in cirrhotic patients. Future research is needed to determine whether these patients might benefit from dialysis.http://dx.doi.org/10.1155/2022/5506744 |
| spellingShingle | Jad Chidiac Rebecca Kassab Mirella Iskandar Sahar Koubar Mabel Aoun Metformin-Associated Lactic Acidosis in a Diabetic Patient with Normal Kidney Function and Occult Cirrhosis Case Reports in Critical Care |
| title | Metformin-Associated Lactic Acidosis in a Diabetic Patient with Normal Kidney Function and Occult Cirrhosis |
| title_full | Metformin-Associated Lactic Acidosis in a Diabetic Patient with Normal Kidney Function and Occult Cirrhosis |
| title_fullStr | Metformin-Associated Lactic Acidosis in a Diabetic Patient with Normal Kidney Function and Occult Cirrhosis |
| title_full_unstemmed | Metformin-Associated Lactic Acidosis in a Diabetic Patient with Normal Kidney Function and Occult Cirrhosis |
| title_short | Metformin-Associated Lactic Acidosis in a Diabetic Patient with Normal Kidney Function and Occult Cirrhosis |
| title_sort | metformin associated lactic acidosis in a diabetic patient with normal kidney function and occult cirrhosis |
| url | http://dx.doi.org/10.1155/2022/5506744 |
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