[A case of severe metformin-associated lactic acidosis treated with CVVHDF and regional anticoagulation with sodium citrate].

Abstract

Metformin is an antidiabetic drug; used to treat type II diabetes mellitus, metformin associated lactic acidosis has an incidence of 2-9 cases / 100,000 patients / year with high mortality (30%). We have had the case of a 75-year-old woman with metabolic acidosis as a result of metformin assumption, treated by renal replacement therapy (CRRT) with continuous veno-venous hemodiafiltration (CVVHDF).

RESULTS:

after a short treatment period there was a reduction in Lactates (from 16.8 mmol/L to 12.6 mmol/L) and a progressive improvement of acidosis. In 72 hours the recovery of diuresis and subsequent suspension of CRRT was achieved.

CONCLUSION:

CRRT, in addition to ensuring support for renal failure and volume correction, allowed a rapid recovery from metformin-associated lactic acidosis.

• Authors: Matteo Ferrario, Antonio Apicella, Mauro Della Morte, Enrico Beretta
• Journal: Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia (G Ital Nefrol) Vol. 35 Issue 5 (Sep 2018) ISSN: 1724-5990 [Electronic] Italy
• PMID: 30234235 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.

Chemical References

• Anticoagulants
• Hypoglycemic Agents
• Piperacillin, Tazobactam Drug Combination
• Sodium Citrate
• Furosemide
• Sodium Bicarbonate
• Metformin

Topics

• Acidosis, Lactic (chemically induced, complications, drug therapy)
• Aged
• Anticoagulants (therapeutic use)
• Bronchial Spasm (etiology)
• Combined Modality Therapy
• Female
• Furosemide (therapeutic use)
• Hemodiafiltration
• Humans
• Hypoglycemic Agents (adverse effects)
• Hypotension (etiology)
• Metformin (adverse effects)
• Piperacillin, Tazobactam Drug Combination (therapeutic use)
• Sodium Bicarbonate (therapeutic use)
• Sodium Citrate (therapeutic use)