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

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This case describes metformin-associated lactic acidosis (MALA), a rare but serious complication that should be suspected in patients taking metformin who develop unexplained lactic acidosis, acidemia, low bicarbonate, and renal impairment. Diagnosis is clinical and supported by elevated lactate, high anion gap, severe acidemia, and kidney dysfunction; metformin levels may help confirm exposure but do not reliably reflect severity.<br /><br />A 69-year-old woman with type 2 diabetes on metformin and a history of heart failure with preserved ejection fraction presented with three days of abdominal pain, nausea, vomiting, and diarrhea. She was hemodynamically stable initially, but labs showed an anion gap metabolic acidosis, creatinine 6.32 mg/dL (baseline 0.9), and lactate 11 mmol/L. Imaging and cardiac evaluation were unrevealing.<br /><br />She was admitted to the ICU, treated with aggressive IV fluids and empiric antibiotics, and then developed hypotension and hypothermia. Because of concern for MALA in the setting of acute kidney injury from gastrointestinal fluid losses, she received norepinephrine, bicarbonate infusion, and emergent hemodialysis. After the second dialysis session, her lactate normalized, kidney function improved, and acid-base abnormalities corrected. Cultures remained negative, antibiotics were stopped, and her metformin level later returned elevated at 25 mcg/mL. She was discharged five days later, and metformin was discontinued.<br /><br />The case emphasizes that supportive care is the main treatment for MALA, with severe cases requiring vasopressors, ventilation, and renal replacement therapy. Early recognition and dialysis can be lifesaving.

Asset Subtitle

Hamam Aneis

Meta Tag

Author List Hamam Aneis, Rimsha Shariff

Category Clinical Vignettes

Concept Metformin-Associated Lactic Acidosis

Concept Metformin

Concept Lactic Acidosis

Concept Hemodialysis

Concept Metabolic Acidosis

Distinguished Non-Finalist

Presenter Organization University of Pittsburgh Medical Center

Presenting Author Hamam Aneis

Track Adult

Keywords

metformin-associated lactic acidosis

MALA

lactic acidosis

metformin

acute kidney injury

hemodialysis

anion gap metabolic acidosis

renal impairment

type 2 diabetes

bicarbonate infusion

Metformin-Associated Lactic Acidosis

Metformin

Lactic Acidosis

Hemodialysis

Metabolic Acidosis