Metformin-Induced Hemolysis in a Patient With Glucose-6-Phosphate Dehydrogenase Deficiency Presenting With Concurrent Idiopathic Steven-Johnson Syndrome/Toxic Epidermal Necrolysis

Choudhury, Avijoy Roy; Gadaga, Cecilia; Moodley, Layuren; Moodley, Aru

doi:10.7759/cureus.18506

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…These reports emphasize the need for clinicians to be vigilant for G6PD deficiency in patients presenting with DKA and hemolysis, especially in regions with a high prevalence of non-Mediterranean variants of G6PD deficiency. Although metformin was reported to trigger hemolysis in G6PD [ 15 ], our patient was already off medication for the last eight months prior to his admission.…”

Section: Discussionmentioning

confidence: 99%

Exploring the Possible Link Between Diabetic Ketoacidosis, Glucose-6-Phosphate Dehydrogenase Deficiency, and Methemoglobinemia

Alsubaie,

Almusalami

2024

Cureus

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One of the most widespread enzymopathies affecting human beings is glucose-6-phosphate dehydrogenase (G6PD) deficiency, which is brought on by inherited mutations in the X-linked gene. Red blood cells (RBCs) with a G6PD deficiency are more sensitive to oxidative assault and consequently to hemolysis. There are more than 200 known G6PD mutations, of which around half are polymorphic and thus prevalent in a variety of populations. We present a case of diabetic ketoacidosis (DKA), with severe hemolytic anemia and methemoglobinemia. The patient was admitted to the intensive care unit, treated for DKA, and received a blood transfusion. In addition, the patient presented with high methemoglobin levels and features of severe hemolytic anemia from the onset, which made the diagnostic consideration of G6PD highly likely. Accordingly, the patient was treated with several doses of ascorbic acid instead of methylene blue. In a nutshell, a patient with DKA who has hemolytic anemia has to have it properly evaluated and controlled. The link between methemoglobinemia, G6PD deficiency, and DKA should be recognized by medical professionals, particularly when oxygen saturation gaps are found.

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Section: Discussionmentioning

confidence: 99%

Exploring the Possible Link Between Diabetic Ketoacidosis, Glucose-6-Phosphate Dehydrogenase Deficiency, and Methemoglobinemia

Alsubaie,

Almusalami

2024

Cureus

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Metformin-Induced Hemolysis in a Glucose-6-Phosphate Dehydrogenase-Deficient Patient: A Case Report

Jumani,

Ibrahim,

Purra

et al. 2024

Cureus

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Metformin is a first-line medication used in the treatment of type 2 diabetes mellitus along with other conditions such as insulin resistance and polycystic ovarian syndrome. Overall, metformin appears to be well tolerated with a low incidence of side effects; however, in certain high-risk populations, it can trigger a hemolytic crisis. This case report describes a middle-aged man who was initiated on metformin for new-onset diabetes, following which he had an acute hemoglobin drop and was diagnosed to be having a hemolytic crisis requiring hospitalization. He was diagnosed with a deficiency of the enzyme glucose-6-phosphate dehydrogenase (G6PD) on admission. Extensive workup was done to rule out other causes of hemolysis, all of which came back to be negative. The offending agent was stopped and the patient received supportive care after which he improved. This case highlights a rare, yet important, side effect of metformin that needs to be observed in certain individuals, especially patients with G6PD deficiency. Routine testing of high-risk populations known to be G6PD deficient should be considered before initiating metformin.

show abstract

Metformin-Induced Hemolysis in a Patient With Glucose-6-Phosphate Dehydrogenase Deficiency Presenting With Concurrent Idiopathic Steven-Johnson Syndrome/Toxic Epidermal Necrolysis

Cited by 2 publications

References 10 publications

Exploring the Possible Link Between Diabetic Ketoacidosis, Glucose-6-Phosphate Dehydrogenase Deficiency, and Methemoglobinemia

Exploring the Possible Link Between Diabetic Ketoacidosis, Glucose-6-Phosphate Dehydrogenase Deficiency, and Methemoglobinemia

Metformin-Induced Hemolysis in a Glucose-6-Phosphate Dehydrogenase-Deficient Patient: A Case Report

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