title: A Fatal Case of Metformin-associated Lactic Acidosis.
abstract: A 72-year-old woman with a history of type 2 diabetes mellitus was brought to the ER with metformin-associated lactic acidosis. She received continuous hemofiltration and hemodialysis, but the laboratory analyses showed no improvement. She died 11 hours after admission. Metformin is minimally bound to proteins and is readily dialyzable, but a prolonged period of dialysis is required, because metformin has a very large distribution volume and is distributed to multiple compartments. The peak blood metformin level was 432 mg/L in this case, which is one of the highest metformin concentrations ever reported, and eight hours of hemodialysis were not sufficient to reduce the serum level.
authors.affiliation: Department of Nephrology, Chubu Rosai Hospital, Japan.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Ozeki
authors.forename: Rui
authors.initials: R
authors.lastname: Kawato
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Watanabe
authors.forename: Shun
authors.initials: S
authors.lastname: Minatoguchi
authors.forename: Yukari
authors.initials: Y
authors.lastname: Murai
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ryuge
authors.forename: Koji
authors.initials: K
authors.lastname: Takasugi
authors.forename: Takuya
authors.initials: T
authors.lastname: Hamada
authors.forename: Yukako
authors.initials: Y
authors.lastname: Oyama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nomura
authors.forename: Tatsuhito
authors.initials: T
authors.lastname: Tomino
authors.forename: Hideaki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Fujita
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000628:therapy*; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000503:physiopathology; D017809:Fatal Outcome; D005260:Female; D005440:Fluid Therapy; D017583:Hemodiafiltration; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008687:Metformin / Q000008:administration & dosage / Q000009:adverse effects*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014667:Vasopressins / Q000008:administration & dosage
chemical_list: D007004:Hypoglycemic Agents; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D008687:Metformin