Dialysis Rounds A Dialysis Case Presentation and Discussion Edited by Roger A. Rodby : Severe Lactic Acidosis Treated with Prolonged Hemodialysis: Recovery After Massive Overdoses of Metformin
2006; Wiley; Volume: 19; Issue: 1 Linguagem: Inglês
10.1111/j.1525-139x.2006.00123.x
ISSN1525-139X
AutoresPeter Y. F. Guo, Leroy Storsley, S. Neil Finkle,
Tópico(s)Diabetes Treatment and Management
ResumoABSTRACT We report two cases of severe lactic acidosis due to massive metformin ingestion. The first case was a 37‐year‐old man who was discovered several hours after ingesting 45 g of metformin. He had severe lactic acidosis (blood pH 6.81bicarbonate 4 mEq/Llactate 25.7 mEq/L). Despite intravenous bicarbonate therapyhe decompensated and was placed on a combination of hemodialysis and charcoal hemoperfusion for a continuous time of 25 hours. His hospital course was complicated by acute renal failure requiring a period of intermittent hemodialysis. He has since made a complete recovery. The second case was a 53‐year‐old man who ingested 50 g of metformin. He also presented with severe lactic acidosis (blood pH 6.85bicarbonate 3 mEq/L and lactate 28.4 mEq/L) and deteriorated despite intravenous bicarbonate therapy. He was placed on hemodialysis as a continuous therapy for 21 hours. His hospital course was complicated by acute renal failure requiring a period of intermittent hemodialysis. He has subsequently made a complete recovery. Metformin‐associated lactic acidosis carries a high mortality rate. Prolonged hemodialysis should be considered as an early treatment option in these cases.
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