Case Report
Year 2025,
Volume: 16 Issue: 54, 56 - 59, 12.04.2025
Abstract
Diabetes mellitus is a common disease worldwide. Metformin is included in the first-line treatment of type 2 diabetes mellitus. Metformin-associated lactic acidosis (MALA) is rare but can be life-threatening. In this case report, MALA and acute kidney injury (AKI) were detected in a 74-year-old female patient who presented with impaired consciousness. The patient was treated with hydration and hemodialysis (HD). MALA diagnosis was based on metformin levels > 5 mg/L, decreased pH, low bicarbonate levels, lactate levels > 5 mmol/L, and increased anion gap.
Supporting Institution
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References
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- Song A, Zhang C, Meng X. Mechanism and application of metformin in kidney diseases: An update. Biomedicine & Pharmacotherapy, 2021;138:111454. https://doi.org/10.1016/j.biopha.2021.111454.
- Aldobeaban S, Mzahim B and Alshehri AA. Recurrent hypoglycemia secondary to metformin toxicity in the absence of co-ingestions: a case repor, JMCR 2018; 12:223. https://doi.org/10.1186/s13256-018-1758-0
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- Simon EL, Sherry AC, Rabinowitz J. Metformin-Associated Lactic Acidosis-Is This on Your Radar?. JEM, 2024;66(4): e530-e533. https://doi.org/10.1016/j.jemermed.2023.11.017
- DeFronzo R, Fleming GA, Chen K, Bicsak TA. Metformin-associated lactic acidosis: Current perspectives on causes and risk. Metabol, 2016;65(2): 20-29. https://doi.org/10.1016/j.metabol.2015.10.014.
- Di Mauro S, Filippello A, Scamporrino A, Purrello F, Piro S, Malaguarnera R. Metformin: when should we fear lactic acidosis?. Int. J. Mol. Sci, 2022;23(15):8320. https://doi.org/10.3390/jms23158320
- See KC. Metformin-associated lactic acidosis: A mini review of pathophysiology, diagnosis and management in critically ill patients. WJD, 2024;15(6):1178. https://doi.org/10.4239/wjd.v15.i6.1178
- Corchia A, Wynckel A, Journet J, Moussi Frances J, Skandrani N, Lautrette A, Rieu P. Metformin-related lactic acidosis with acute kidney injury: results of a French observational multicenter study. Clinical Toxicology, 2020;58(5): 375-382. https://doi.org/10.1080/15563650.2019.1648816
- Kim S, Sarwal A, Yee XT, Fraga SAG, Campion V, Gnanasekaran I. Metformin-associated lactic acidosis (MALA): Is it an underestimated entity? A retrospective, single-center case series. Hemodialysis International, 2024;28(1):32-39. https://doi.org/10.1111/hdi.13113
- Goonoo MS, Morris R, Raithatha A, Creagh F. Metformin-associated lactic acidosis: reinforcing learning points. DTB, BMJ, 2020;13(9): e235608. https://doi.org/10.1136/dtb.2021.235608rep
- Vordoni A, Theofilis P, Vlachopanos G, Koukoulaki M, Kalaitzidis RG. Metformin-associated lactic acidosis and acute kidney injury in the era of COVID-19. Frontiers in Bioscience-Scholar, 2021;13(2):202-207. https://doi.org/10.52586/S563
- Ariga M, Hagita J, Soda M, Oida Y, Teramachi H, Kitaichi K. Daily dose of metformin caused acute kidney injury with lactic acidosis: a case report. JMCR, 2023;17(1): 393. https://doi.org/10.1186/s13256-023-04136-0
- Alotaibi M, Ali F, Leung S, Kent R. Metformin Induced Lactic Acidosis What Is the Effective Treatment?. OJNeph, 2020;10(1): 11-17. https://doi.org/10.4236/ojneph.2020.101002
- Wills BK, Bryant SM, Buckley P, Seo B. Can acute overdose of metformin lead to lactic acidosis? Am J Emerg Med. 2010;28(8):857-861. https://doi.org/10.1016/j.ajem.2009.04.012
- Calello DP, Liu KD, Wiegand TJ, Roberts DM, Lavergne V, Gosselin S, Hoffman RS, Nolin TD, Ghannoum M., Extracorporeal Treatments in Poisoning Workgroup. Extracorporeal Treatment for Metformin Poisoning: Systematic Review and Recommendations From the Extracorporeal Treatments in Poisoning Workgroup. Crit Care Med. 2015;43(8):1716-1730. https://doi.org/10.1097/ccm.0000000000001002
- Eppenga WL, Lalmohamed A, Geerts AF, Derijks HJ, Wensing M, Egberts A, et al. Risk of lactic acidosis or elevated lactate concentrations in metformin users with renal impairment: a population-based cohort study. Diabetes Care. 2014;37(8):2218–2224. https://doi.org/10.2337/dc13-3023
Year 2025,
Volume: 16 Issue: 54, 56 - 59, 12.04.2025
Abstract
References
- Perveen W, Ahsan H, Shahzad R, Fayyaz S, Zaif A, Paracha MA, Alghadir AH. Prevalence of peripheral neuropathy, amputation, and quality of life in patients with diabetes mellitus. Scientific Reports, 2024;14(1):14430. https://doi.org/10.1038/s41598-024-65495-2
- Song A, Zhang C, Meng X. Mechanism and application of metformin in kidney diseases: An update. Biomedicine & Pharmacotherapy, 2021;138:111454. https://doi.org/10.1016/j.biopha.2021.111454.
- Aldobeaban S, Mzahim B and Alshehri AA. Recurrent hypoglycemia secondary to metformin toxicity in the absence of co-ingestions: a case repor, JMCR 2018; 12:223. https://doi.org/10.1186/s13256-018-1758-0
- CorcoranC. Metformin. ; Tibb F. Jacobs. StatPearls Publishing; 2024
- Dyatlova N, Tobarran NV, Kannan L, North R, Wills BK. Metformin associated lactic acidosis (MALA). 2022.
- Simon EL, Sherry AC, Rabinowitz J. Metformin-Associated Lactic Acidosis-Is This on Your Radar?. JEM, 2024;66(4): e530-e533. https://doi.org/10.1016/j.jemermed.2023.11.017
- DeFronzo R, Fleming GA, Chen K, Bicsak TA. Metformin-associated lactic acidosis: Current perspectives on causes and risk. Metabol, 2016;65(2): 20-29. https://doi.org/10.1016/j.metabol.2015.10.014.
- Di Mauro S, Filippello A, Scamporrino A, Purrello F, Piro S, Malaguarnera R. Metformin: when should we fear lactic acidosis?. Int. J. Mol. Sci, 2022;23(15):8320. https://doi.org/10.3390/jms23158320
- See KC. Metformin-associated lactic acidosis: A mini review of pathophysiology, diagnosis and management in critically ill patients. WJD, 2024;15(6):1178. https://doi.org/10.4239/wjd.v15.i6.1178
- Corchia A, Wynckel A, Journet J, Moussi Frances J, Skandrani N, Lautrette A, Rieu P. Metformin-related lactic acidosis with acute kidney injury: results of a French observational multicenter study. Clinical Toxicology, 2020;58(5): 375-382. https://doi.org/10.1080/15563650.2019.1648816
- Kim S, Sarwal A, Yee XT, Fraga SAG, Campion V, Gnanasekaran I. Metformin-associated lactic acidosis (MALA): Is it an underestimated entity? A retrospective, single-center case series. Hemodialysis International, 2024;28(1):32-39. https://doi.org/10.1111/hdi.13113
- Goonoo MS, Morris R, Raithatha A, Creagh F. Metformin-associated lactic acidosis: reinforcing learning points. DTB, BMJ, 2020;13(9): e235608. https://doi.org/10.1136/dtb.2021.235608rep
- Vordoni A, Theofilis P, Vlachopanos G, Koukoulaki M, Kalaitzidis RG. Metformin-associated lactic acidosis and acute kidney injury in the era of COVID-19. Frontiers in Bioscience-Scholar, 2021;13(2):202-207. https://doi.org/10.52586/S563
- Ariga M, Hagita J, Soda M, Oida Y, Teramachi H, Kitaichi K. Daily dose of metformin caused acute kidney injury with lactic acidosis: a case report. JMCR, 2023;17(1): 393. https://doi.org/10.1186/s13256-023-04136-0
- Alotaibi M, Ali F, Leung S, Kent R. Metformin Induced Lactic Acidosis What Is the Effective Treatment?. OJNeph, 2020;10(1): 11-17. https://doi.org/10.4236/ojneph.2020.101002
- Wills BK, Bryant SM, Buckley P, Seo B. Can acute overdose of metformin lead to lactic acidosis? Am J Emerg Med. 2010;28(8):857-861. https://doi.org/10.1016/j.ajem.2009.04.012
- Calello DP, Liu KD, Wiegand TJ, Roberts DM, Lavergne V, Gosselin S, Hoffman RS, Nolin TD, Ghannoum M., Extracorporeal Treatments in Poisoning Workgroup. Extracorporeal Treatment for Metformin Poisoning: Systematic Review and Recommendations From the Extracorporeal Treatments in Poisoning Workgroup. Crit Care Med. 2015;43(8):1716-1730. https://doi.org/10.1097/ccm.0000000000001002
- Eppenga WL, Lalmohamed A, Geerts AF, Derijks HJ, Wensing M, Egberts A, et al. Risk of lactic acidosis or elevated lactate concentrations in metformin users with renal impairment: a population-based cohort study. Diabetes Care. 2014;37(8):2218–2224. https://doi.org/10.2337/dc13-3023
There are 18 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | Case Reports |
| Authors | |
| Publication Date | April 12, 2025 |
| Submission Date | October 17, 2024 |
| Acceptance Date | December 30, 2024 |
| Published in Issue | Year 2025 Volume: 16 Issue: 54 |