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Colegio de Medicina Interna de México.

2021, Number 6

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Med Int Mex 2021; 37 (6)

Replacement therapy for metabolic acidosis with hyperlactatemia secondary to acute metformin intoxication

León-Ortiz AG, Pérez-Martínez P, Pozas-Ocampo LE, Sánchez-Zúñiga MJ, Carrillo-Esper R

Language: Spanish
References: 29
Page: 1114-1119
PDF size: 192.82 Kb.


ABSTRACT

Background: Metformin, in toxic doses, can cause resistant metabolic acidosis with hyperlactatemia, without hypoglycemia, contrary to what might be thought, considering it a hypoglycemic agent.
Clinical case: A 52-year-old male patient, who was found with severe metabolic acidosis and hyperlactatemia secondary to the ingestion of 17 g of metformin, without repercussion in glycemia. Initially treated with life support, which consisted of advanced airway management, intravenous fluids, hemodynamic support with vasopressors and sodium bicarbonate as previous therapy to definitive treatment with hemodialysis. There is evidence of improvement of metabolic acidosis after the first session of hemodialysis with persistence of hyperlactatemia. Considering the redistribution of the agent, described in the literature, got into a second session of hemodialysis, reversing indicators of severity.
Conclusions: The clinical manifestations of acute metformin intoxication usually begin late, so patients suspected of having ingested toxic doses should be closely monitored.


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