A Fatal Case of Metformin-associated Lactic Acidosis

• Published in: Internal Medicine Vol. 55; no. 7; pp. 775 - 778
• Main Authors: Ozeki, Toshikazu, Kawato, Rui, Watanabe, Mitsuru, Minatoguchi, Shun, Murai, Yukari, Ryuge, Akihiro, Takasugi, Koji, Hamada, Takuya, Oyama, Yukako, Nomura, Atsushi, Tomino, Tatsuhito, Shimizu, Hideaki, Fujita, Yoshiro
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.01.2016
• Subjects: acidosis; Acidosis, Lactic - chemically induced; Acidosis, Lactic - therapy; Aged; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - physiopathology; Fatal Outcome; Female; Fluid Therapy; Hemodiafiltration; hemodialysis; Humans; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; lactate; metformin; Metformin - administration & dosage; Metformin - adverse effects; Vasoconstrictor Agents - administration & dosage; Vasopressins - administration & dosage
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.55.5415

A 72-year-old woman with a history of type 2 diabetes mellitus was brought to the ER with metformin-associated lactic acidosis. She received continuous hemofiltration and hemodialysis, but the laboratory analyses showed no improvement. She died 11 hours after admission. Metformin is minimally bound to proteins and is readily dialyzable, but a prolonged period of dialysis is required, because metformin has a very large distribution volume and is distributed to multiple compartments. The peak blood metformin level was 432 mg/L in this case, which is one of the highest metformin concentrations ever reported, and eight hours of hemodialysis were not sufficient to reduce the serum level.