Transient vision loss in a patient with severe metformin-associated lactic acidosis

Cigarrán, Secundino; Rodríguez, Marcelo; Pousa, Marcelo Sampaio; Menéndez, Héctor; Méndez, Miguel

doi:10.1093/qjmed/hcr109

Cited by 15 publications

(11 citation statements)

References 15 publications

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“…[5][6][7][8] There have been a small number of other reports of reversible blindness with alcoholic ketoacidosis and also lactic acidosis. [9][10][11] The common factor in all of these cases, along with our case, was a pH <7.0 and the full recovery of vision with normalisation of pH.…”

Section: Discussionsupporting

confidence: 66%

Reversible Blindness Secondary to Severe Diabetic Ketoacidosis

Oun

Lloyd

2018

Journal of the Royal College of Physicians of Edinburgh

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We present a case of sudden-onset reversible blindness secondary to severe diabetic ketoacidosis. The exact mechanism is not fully understood but is postulated to be due to uncoupling of retinal electrical transmission in a severe acidic environment. This report adds to the small number of reported cases of reversible blindness secondary to severe diabetic ketoacidosis and serves to raise awareness of this unusual diagnosis. It should be considered in patients who present with acute-onset reversible bilateral blindness only after other causes are excluded via detailed retinal examination and cranial imaging.

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Section: Discussionsupporting

confidence: 66%

Reversible Blindness Secondary to Severe Diabetic Ketoacidosis

Oun

Lloyd

2018

Journal of the Royal College of Physicians of Edinburgh

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“…If extrapolated to humans, this could explain the reason for loss of vision in the associated severe acidosis. 6 Sudden vision loss has also been reported previously with both diabetic and alcoholic ketoacidosis. The common denominator among these patients was both a severe metabolic acidosis and reversal of abnormal vision symptoms with correction of serum pH.…”

Section: How Might This Improve Emergency Medicine Practice?mentioning

confidence: 63%

“…3,4 Reversible vision loss is a highly unusual complication of MALA and has very rarely been reported. [5][6][7][8][9] Metformin is a small drug (165 kilodalton) with an oral bioavailability of 50%. Since it is not metabolized by the liver, tubular secretion is the primary elimination route.…”

Section: Introductionmentioning

confidence: 99%

Reversible Total Vision Loss Caused by Severe Metformin-associated Lactic Acidosis: A Case Report

Koons

Amaducci

Katz

2021

Clinical Practice and Cases in Emergency Medicine

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Introduction: Metformin is a biguanide used to treat diabetes mellitus (DM). Metformin-associated lactic acidosis (MALA) carries a high mortality and can occur in patients with renal failure from drug bioaccumulation. Reversible vision loss is a highly unusual, rarely reported complication of MALA. We present a case of a patient whose serum metformin concentration was unusually high and associated with vision loss. Case Report: A 60-year-old woman presented to an outside hospital emergency department with acute vision loss after being found at home confused, somnolent, and hypoglycemic, having last being seen normal two days prior. She reported vomiting and diarrhea during that time and a recently treated urinary tract infection. The visual loss resolved with continuous renal replacement therapy. Conclusion: This novel case of a patient with Type II DM prescribed metformin and insulin who developed reversible vision loss while suffering from MALA highlights the potential for vision loss in association with MALA.

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“…It is not easy to distinguish between blindness related to MALA and blindness related to other causes. In previous cases, reversible blindness due to lactic acidosis was reported in diabetic patients89); a case of transient blindness due to diabetic ketoacidosis (DKA) and due to alcoholic ketoacidosis have also been reported1011). The common features of these cases were severe metabolic acidosis with pH <7.0 and bicarbonate <5.0mmol/L, and restoration of visual acuity after metabolic acidosis was corrected (Table 2).…”

Section: Discussionmentioning

confidence: 94%

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

Jeon

Choi

Kim

et al. 2019

Electrolyte Blood Press

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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.

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Transient vision loss in a patient with severe metformin-associated lactic acidosis

Cited by 15 publications

References 15 publications

Reversible Blindness Secondary to Severe Diabetic Ketoacidosis

Reversible Blindness Secondary to Severe Diabetic Ketoacidosis

Reversible Total Vision Loss Caused by Severe Metformin-associated Lactic Acidosis: A Case Report

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

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