title: Severe lactic acidosis treated with prolonged hemodialysis: recovery after massive overdoses of metformin.
abstract: 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 6.81, bicarbonate 4 mEq/L, lactate 25.7 mEq/L). Despite intravenous bicarbonate therapy, he 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 6.85, bicarbonate 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.
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Peter Y F
authors.initials: PY
authors.lastname: Guo
authors.forename: Leroy J
authors.initials: LJ
authors.lastname: Storsley
authors.forename: S Neil
authors.initials: SN
authors.lastname: Finkle
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000628:therapy*; D000328:Adult; D062787:Drug Overdose; D006801:Humans; D007004:Hypoglycemic Agents / Q000506:poisoning*; D008297:Male; D008687:Metformin / Q000506:poisoning*; D008875:Middle Aged; D006435:Renal Dialysis; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin