title: Metformin-induced lactic acidosis and acute pancreatitis precipitated by diuretic, celecoxib, and candesartan-associated acute kidney dysfunction.
abstract: Polypharmacy may lead to synergistic complications from the different medications. We report the case of a 50-year-old woman who was prescribed 11 drugs, including a diuretic, celecoxib, metformin, and candesartan, and who developed acute kidney dysfunction while on these drugs, manifesting as severe proteinuria, acute azotemia, hyperkalemia. The kidney injury caused the accumulation of metformin, leading to lactic acidosis and acute pancreatitis. Sodium bicarbonate hemodialysis not only improved the metabolic abnormalities but also hastened the removal of metformin.
authors.affiliation: Beth Israel Medical Center, Nephrology and Hypertension, New York, New York 10003, USA.
authors.forename: Pat
authors.initials: P
authors.lastname: Audia
authors.forename: Donald A
authors.initials: DA
authors.lastname: Feinfeld
authors.forename: Alan
authors.initials: A
authors.lastname: Dubrow
authors.forename: James F
authors.initials: JF
authors.lastname: Winchester
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced*; D000208:Acute Disease; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use; D001562:Benzimidazoles / Q000009:adverse effects / Q000627:therapeutic use; D001713:Biphenyl Compounds; D000068579:Celecoxib; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects / Q000627:therapeutic use; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D008687:Metformin / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D010195:Pancreatitis / Q000139:chemically induced*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D019338:Polypharmacy; D011720:Pyrazoles / Q000009:adverse effects / Q000627:therapeutic use; D006435:Renal Dialysis / Q000379:methods; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use; D013777:Tetrazoles / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D016861:Cyclooxygenase Inhibitors; D004232:Diuretics; D007004:Hypoglycemic Agents; D004364:Pharmaceutical Preparations; D011720:Pyrazoles; D013449:Sulfonamides; D013777:Tetrazoles; D006852:Hydrochlorothiazide; D017693:Sodium Bicarbonate; D008687:Metformin; D000068579:Celecoxib; C081643:candesartan