Metformin-associated lactic acidosis: reinforcing learning points

Goonoo, Mohummad Shaan; Morris, Rebecca A.; Raithatha, Ajay; Creagh, F. M.

doi:10.1136/bcr-2020-235608

Cited by 7 publications

(4 citation statements)

References 41 publications

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“…Previous studies have showed that people with chronic diseases such as T2DM often experience depression and anxiety, which can lead to suicidal behavior ( Semenkovich et al, 2015 ; Kim et al, 2022 ). Risky drugs include high doses of insulin, metformin, glipizide, liraglutide and sitagliptin ( Sarkar and Balhara, 2014 ; Goonoo et al, 2020 ; Tuncali et al, 2021 ). Our case further indicated that vildagliptin is also a potential drug for suicide and self-harm, which should be particularly noted in depressed individuals.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Rhabdomyolysis secondary to vildagliptin overdose in a suicidal attempt: A case report and brief literature review

et al. 2022

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Rhabdomyolysis is a life-threatening syndrome associated with direct or indirect muscle damage that is rarely reported with dipeptidyl peptidase (DPP)-4 inhibitors. Here we presented a case in which a 58-year-old female suffered from severe swelling and pain in bilateral lower limbs and oliguria after a suicidal vildagliptin overdose. Drug-induced rhabdomyolysis and drug-induced liver injury were diagnosed based on laboratory and radiological findings. The patient was treated with fluid resuscitation, insulin, electrolyte replacement, diuretics, urine alkalizing agents, anticoagulants, antioxidants, and 24-h bedside ECG monitoring and suicide prevention. After 20 days of hospitalization and close monitoring, the patient was discharged without sequelae. Risk factors, diagnostic criteria, disease mechanisms, and outcomes were also discussed. This case illustrated that overdose of oral anti-diabetic medications may result in clinically significant adverse events, such as rhabdomyolysis in this case with a DPP-4 inhibitor. Although the incidence is low, special attention should be paid to intentional or accidental exposure to anti-diabetic medications during suicide attempts, especially in depressed patients with diabetes.

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Section: Discussionmentioning

confidence: 99%

Case Report: Rhabdomyolysis secondary to vildagliptin overdose in a suicidal attempt: A case report and brief literature review

et al. 2022

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“…Metformin-associated lactic acidosis is a rare complication of metformin treatment of type 2 diabetes, which can be caused due to take in large amount of the drug, or it can be provoked comorbidities such as renal or hepatic insufficiency or acute infection. Clinically, MALA can be presented with gastrointestinal symptoms (nausea, vomiting and diarrhea), altered mental status, hypotension and hypothermia [1]. In patients with hemodynamic instability due to septic shock and MALA, continuous renal replacement therapy (CRRT) has been reported to be successful.…”

Section: Introductionmentioning

confidence: 99%

Early initiation of continuous renal replacement therapy for metformin-associated lactic acidosis

et al. 2023

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Introduction. Rapid diagnosis of metformin-associated lactic acidosis (MALA) and initiation of continuous renal replacement therapy (CRRT) in diabetic patient successfully corrects a severe metabolic disorder of a patient with acute renal failure. Case outline. A 58-year-old male patient with a medical history of type 2 diabetes and alcohol abuse was admitted to Emergency department because of the vomiting, diarrhea and altered mental status. Initial arterial blood gas (ABG) analysis revealed severe metabolic acidosis (pH: 6.8, PaCO2: 12 mmHg, HCO3: 3.2 mmol/l), but the lactate level was too high to measure. MALA was suspected based on progressive lactic acidosis and past intake of metformin. The renal replacement therapy (RRT) was initiated- continuous veno-venous hemodiafiltration (CVVHDF), and as a result a significant improvement of the clinical status, with both blood pH and lactate level showing normalization was achieved after finishing CRRT. Conclusion. Acute metformin-associated lactic acidosis carries an ominous prognosis. This case suggests the application of early initiation of CRRT in hemodynamically unstable diabetic patients with MALA.

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“…Hypoglycaemia and less commonly hyperglycaemia have also been reported in patients with acute metformin overdose. (7,8,9,10) MALA is a well-recognized, potentially fatal, rare adverse effect that is reported in acute overdose (11,12,13). MALA has also been described in patients with acute on chronic metformin toxicity, end stage renal disease and in patients with acute renal failure on chronic metformin therapy (13,14).…”

Section: Introductionmentioning

confidence: 99%

“…(7,8,9,10) MALA is a well-recognized, potentially fatal, rare adverse effect that is reported in acute overdose (11,12,13). MALA has also been described in patients with acute on chronic metformin toxicity, end stage renal disease and in patients with acute renal failure on chronic metformin therapy (13,14). Its incidence varies from 3 to 10 per 100 000 patients (11,14,15,16).…”

Section: Introductionmentioning

confidence: 99%

Severe Metformin poisoning; Experience at a tertiary care hospital in Sri Lanka: a case series

Sirisena¹,

Hettiarachchi²,

Manilgama

et al. 2022

Asian J. Internal Med.

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Metformin is the first line medication used for the treatment of type 2 diabetes mellitus worldwide. It has been considered a cost effective and safe drug for decades. Though, lactic acidosis is a recognized adverse effect of metformin, it is sparsely seen with therapeutic doses. However, it occurs frequently in patients with metformin overdose and in the presence of renal insufficiency. Metformin associated lactic acidosis (MALA) carries a mortality rate of almost 50%. Early initiation of renal replacement therapy has shown to reduce morbidity and mortality in these patients. Metformin overdose is relatively uncommon and only few cases of severe metformin overdose are reported in the literature. Here, we discuss five cases of MALA due to severe metformin poisoning. Four of them were successfully treated with early use of renal replacement therapy.

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Metformin-associated lactic acidosis: reinforcing learning points

Cited by 7 publications

References 41 publications

Case Report: Rhabdomyolysis secondary to vildagliptin overdose in a suicidal attempt: A case report and brief literature review

Case Report: Rhabdomyolysis secondary to vildagliptin overdose in a suicidal attempt: A case report and brief literature review

Early initiation of continuous renal replacement therapy for metformin-associated lactic acidosis

Severe Metformin poisoning; Experience at a tertiary care hospital in Sri Lanka: a case series

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