title: Feeling blue with metformin-associated lactic acidosis.
abstract: An active 66-year-old diabetic woman presented with a 5-day history of vomiting and abdominal pain, refractory shock and acute kidney injury (AKI). There was concomitant ACE inhibitor (ACEi) use and metformin toxicity with severe lactic acidosis. She suffered a pulseless electrical activity (PEA) cardiac arrest within 30 min of arrival to the Medical Admissions Unit. Despite a serum pH of 6.57 she was successfully resuscitated. She remained haemodynamically unstable even with fluid resuscitation, inotropic support and haemodiafiltration, yet made a full and rapid recovery following the introduction of a methylene blue infusion.
authors: Postgraduate Medical Education, North Bristol NHS Trust, Bristol, UK. benjamin.plumb@nbt.nhs.uk
authors: Benjamin
authors: B
authors: Plumb
authors: Alex
authors: A
authors: Parker
authors: Paul
authors: P
authors: Wong
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced*; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D008687:Metformin / Q000009:adverse effects*; D008751:Methylene Blue / Q000627:therapeutic use*
chemical_list: D004791:Enzyme Inhibitors; D007004:Hypoglycemic Agents; D008687:Metformin; D008751:Methylene Blue