Transient Blindness in a Patient with Severe Metformin-Associated Lactic Acidosis (MALA)

A 68-year-old man presented at the emergency room with sudden blindness. The day before, he had eaten sashimi and eel and drank alcohol for dinner. He experienced nausea, vomiting, and dizziness afterward. His medical history included hypertension and diabetes, and the latter was treated with metfor...

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Published inElectrolyte & blood pressure : E & BP Vol. 17; no. 1; pp. 16 - 20
Main Authors Jae Wan Jeon, Wonjung Choi, Hae Ri Kim, Young Rok Ham, Dae Eun Choi, Ki Ryang Na, Kang Wook Lee, Soo Ya Bae, Seong Hoon Kim
Format Journal Article
LanguageKorean
Published 대한전해질학회 30.06.2019
Subjects
Hemodialysis
Metabolic acidosis
Metformin-associated lactic acidosis (MALA)
Transient blindness
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Summary:A 68-year-old man presented at the emergency room with sudden blindness. The day before, he had eaten sashimi and eel and drank alcohol for dinner. He experienced nausea, vomiting, and dizziness afterward. His medical history included hypertension and diabetes, and the latter was treated with metformin. Initial laboratory tests revealed severe metabolic acidosis (lactic acidosis). Massive hydration and intravenous sodium bicarbonate replacement therapies were initiated, but severe metabolic acidosis (lactic acidosis) did not resolve, in turn, leading to hemodialysis, which decreased metabolic acidosis. The patient’s blindness improved, and his vision gradually recovered. As it is not easy to distinguish between blindness related to metformin-associated lactic acidosis (MALA) and blindness related to other causes, rapid correction of metabolic acidosis through hemodialysis might be helpful in differentiating this from of blindness from blindness related to other causes.
Bibliography:The Korean Society of Electrolyte Metabolism
ISSN:1738-5997
2092-9935