title: Hemodialysis-refractory metformin-associated lactate acidosis with hypoglycemia, hypothermia, and bradycardia in a diabetic patient with belated diagnosis and chronic kidney disease .
abstract: Metformin is a first-line oral antidiabetic therapy for patients with type 2 diabetes mellitus. Metformin-associated lactate acidosis (MALA) is a well-known, life-threatening, but rare side effect of metformin therapy. Chronic kidney disease (CKD) patients have a much greater risk of MALA. We report the case of a severe refractory MALA despite hemodialysis (HD) treatment, associated with hypoglycemia, hypothermia, and bradycardia in a neglected and thus untimely-recognized CKD patient with type 2 diabetes mellitus. Despite the recent rehabilitation of metformin as a treatment of choice for type 2 diabetes mellitus, the drug should be prescribed with caution as it can be associated with life-threatening refractory acidosis, particularly in CKD patients. Moreover, HD treatment could occasionally be ineffective, resulting in a fatal outcome. .
authors.forename: Lada
authors.initials: L
authors.lastname: Zibar
authors.forename: Karin
authors.initials: K
authors.lastname: Zibar
mesh_terms: D000140:Acidosis, Lactic / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001919:Bradycardia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D057210:Delayed Diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007035:Hypothermia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D007328:Insulin / Q000009:adverse effects; D008687:Metformin / Q000009:adverse effects*; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin