title: Extreme lactic acidosis type B associated with metformin treatment.
abstract: The elimination of metformin is exclusively through the kidneys and elevated plasma concentrations can cause lactic acidosis. We report a case of severe lactic acidosis (pH 6.60) occuring with ostensibly normal therapeutic doses of metformin in the setting of acute renal failure. Continuous veno-venous haemodiafiltration decreased plasma metformin concentrations from 266 lmol/L at presentation to 68 lmol/L, 21 h later. The patient improved rapidly.
authors.affiliation: Department of Anaesthesiology, Skåne University Hospital, Lund University, Malmö, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Pikwer
authors.affiliation: Department of Intensive Care Medicine, Skåne University Hospital, Lund University, Malmö, Sweden.
authors.forename: Einar
authors.initials: E
authors.lastname: Vernersson
authors.affiliation: Department of Endocrinology, Skåne University Hospital, Lund University, Malmö, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Frid
authors.affiliation: Department of Nephrology and Transplantation, Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Sterner
keywords: lactic acidosis; metformin