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Dialysis Rounds
A Dialysis Case Presentation and Discussion
Edited by Roger A. Rodby : Severe Lactic Acidosis Treated with Prolonged Hemodialysis: Recovery After Massive Overdoses of Metformin
Author(s) -
Guo Peter Y. F.,
Storsley Leroy J.,
Finkle S. Neil
Publication year - 2006
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/j.1525-139x.2006.00123.x
Subject(s) - medicine , lactic acidosis , hemodialysis , metformin , acidosis , hemoperfusion , renal replacement therapy , dialysis , metabolic acidosis , surgery , anesthesia , intensive care medicine , insulin
We report two cases of severe lactic acidosis due to massive metformin ingestion. The first case was a 37‐year‐old man who was discovered several hours after ingesting 45 g of metformin. He had severe lactic acidosis (blood pH 6.81bicarbonate 4 mEq/Llactate 25.7 mEq/L). Despite intravenous bicarbonate therapyhe decompensated and was placed on a combination of hemodialysis and charcoal hemoperfusion for a continuous time of 25 hours. His hospital course was complicated by acute renal failure requiring a period of intermittent hemodialysis. He has since made a complete recovery. The second case was a 53‐year‐old man who ingested 50 g of metformin. He also presented with severe lactic acidosis (blood pH 6.85bicarbonate 3 mEq/L and lactate 28.4 mEq/L) and deteriorated despite intravenous bicarbonate therapy. He was placed on hemodialysis as a continuous therapy for 21 hours. His hospital course was complicated by acute renal failure requiring a period of intermittent hemodialysis. He has subsequently made a complete recovery. Metformin‐associated lactic acidosis carries a high mortality rate. Prolonged hemodialysis should be considered as an early treatment option in these cases.