SHM Converge Scientific Abstract ePoster Gallery-An Unexpected Case of Metformin Associated Lactic Acidosis

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This case report describes an unexpected episode of metformin-associated lactic acidosis (MALA) in a 71-year-old man with multiple chronic illnesses, including type 2 diabetes, heart failure, coronary artery disease, COPD, and kidney failure requiring hemodialysis. He presented to the emergency department with constipation but no abdominal pain, nausea, vomiting, or signs of gastrointestinal bleeding. Initial evaluation showed a creatinine of 3.52, an anion gap of 20, and a markedly elevated lactate of 14.7. Although his blood pH was near normal, his lactate continued to rise and eventually peaked at 18.6.<br /><br />The patient had recently been hospitalized for COVID-19 complicated by acute tubular necrosis, and his renal function never recovered. Despite metformin having been discontinued because of renal failure, he was still taking it. Imaging showed a large stool burden, which was relieved by disimpaction. Because of concern for bowel ischemia, a CT scan with IV contrast was performed, but it showed no evidence of ischemia or another clear cause of lactic acidosis.<br /><br />Nephrology was consulted, and the patient was treated with intermittent hemodialysis using a high-flux dialyzer, followed by continuous renal replacement therapy. His lactate level decreased to normal, and he remained asymptomatic throughout hospitalization. With no other etiology identified, metformin was felt to be the cause of the lactic acidosis. He was discharged home with a normal lactate level.<br /><br />The report emphasizes that MALA, though rare, can be life-threatening and is more likely in patients with renal impairment or other conditions that reduce lactate clearance. Prompt recognition, stopping metformin, and initiating dialysis when indicated are critical to reducing morbidity and mortality.

Asset Subtitle

Fakeha Siddiqui

Meta Tag

Author List Ahmed Umer, Fakeha Siddiqui, Michael Iannetti

Category Clinical Vignettes

Concept Metformin-Associated Lactic Acidosis

Concept Renal Disease

Concept Metformin Discontinuation

Concept Lactic Acidosis

Concept Hyperlactatemia

Distinguished Non-Finalist

Presenter Organization WVU School of Medicine

Presenting Author Fakeha Siddiqui

Track Adult

Keywords

metformin-associated lactic acidosis

MALA

type 2 diabetes

renal failure

hemodialysis

lactate elevation

kidney impairment

COVID-19 complications

continuous renal replacement therapy

metformin toxicity

Metformin-Associated Lactic Acidosis

Renal Disease

Metformin Discontinuation

Lactic Acidosis

Hyperlactatemia