title: Myocardial injury and acute renal failure associated with lactic acidosis due to suicide attempt with metformin.
abstract: Metformin-associated lactic acidosis (MALA) is one of the most important drug toxicities with a high morbidity and mortality rate. We report herein a case of suicide attempt with metformin presenting as MALA and acute renal failure on admission to emergency department and acute myocardial injury later on hospitalisation. An obvious improvement of metabolic parameters was seen in our patient provided by anti-ischaemic treatment together with bicarbonate infusion and haemodialysis. Although myocardial injury due to MALA is not a common disorder, we must be aware that metformin overdose with lack of tissue oxygenation, hypoperfusion, and arrhythmias may cause myocardial ischaemia.
authors.affiliation: Department of Internal Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey.
authors.forename: Meltem
authors.initials: M
authors.lastname: Sertbas
authors.affiliation: Department of Internal Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey.
authors.forename: Yasar
authors.initials: Y
authors.lastname: Sertbas
authors.affiliation: Department of Cardiology, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Ordu
authors.affiliation: Department of Internal Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey.
authors.forename: Enver
authors.initials: E
authors.lastname: Berber
authors.affiliation: Department of Internal Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey.
authors.forename: Birgul
authors.initials: B
authors.lastname: Ozen
authors.affiliation: Department of Internal Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Ozdemir
mesh_terms: D000140:Acidosis, Lactic / Q000097:blood / Q000139:chemically induced / Q000150:complications; D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D004632:Emergency Medical Services / Q000379:methods; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008687:Metformin / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006435:Renal Dialysis / Q000379:methods*; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D013406:Suicide, Attempted; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D017693:Sodium Bicarbonate; D008687:Metformin
keywords: Metformin, Lactic acidosis, Myocardial ischaemia.