Metformin-Associated Lactic Acidosis Developed as a Result of a Suicidal Attempt

Metformin is a biguanide group drug commonly used in the treatment of Type 2 DM. Even though Metformin- Associated Lactic Acidosis (MALA) is not seen very frequently, MALA has a high mortality rate. This case is presented to draw attention to efficiency of hemodialysis and CVVHDF tin the treatment of MALA.
A 25-year-old female patient was brought to the emergency service with abdominal pain and confusion. In her detailed history, it was learned that she took 100 tablets of metformin (1000 mg per tablet). Hemodialysis initiated because of severe metabolic acidosis, elevation of blood urea and hyperkalemia were seen in laboratory results. After that, patient was intubated because of low Glasgow Coma Scale (GCS: 3) and vasopressor agent were started due to hypotension. In the intensive care unit, blood glucose was seen 44 mg dl-1 and treated with 10% dextrose solution. CVVHDF treatment was started because of anuria and metabolic acidosis. Patient who underwent CVVHDF treatment for 12-days transferred to nephrology service on the 23rd day of the ICU admission with full consciousness and stabilized vitals.
In conclusion, hemodialysis and CVVHDF should be the first treatment methods to be considered in patients with metformin-associated lactic acidosis. Renal replacement therapies, initiated rapidly and maintained for an adequate time period are promising in this high mortality rate cases.

Özkýyým Sonucu Geliþen Metformin Ýliþkili Laktik Asidoz

AMAÇ: Metformin Tip2 DM tedavisinde sýk kullanýlan biguanid grubu bir ilaçtýr. Metformin iliþkili laktik asidoz (MÝLA) görülme sýklýðý düþük olmakla beraber yüksek mortalite oranlarý ile birliktedir.Bu olgu MÝLA tedavisinde hemodiyaliz ve CVVHDF tedavi etkinliðine dikkat çekmek amacýyla sunulmuþtur.
OLGU: 25 yaþýnda kadýn hasta karýn aðrýsý,þuur bulanýklýðý ile acil servise getirilmiþtir. Detaylý anamnezinde 100 adet 1000 mg metformin tablet aldýðý öðrenilmiþtir. Laboratuar tetkiklerinde derin metabolik asidoz,üre kreatinin yüksekliði ve hiperkalemi görülen hastaya acilen hemodiyaliz uygulanmýþtýr. Sonrasýnda Glasgow Koma Skalasý düþen hasta (GKS: 3) entübe edilmiþ ve hipotansif olmasý nedeniyle vazopressor ajan baþlanmýþtýr. Yoðun bakým ünitesinde kþ: 44 mg dl-1 olarak görülmesi üzerine %10 dextrozlu mayi uygulanmýþtýr. Anüri ve metaboli kasidoz nedeniyle CVVHDF tedavisi baþlanmýþtýr.Yatýþ süresi boyunca 12 gün CVVHDF tedavisi uygulanan hasta ybü yatýþýnýn 23.gününde þuur açýk vitalleri stabil olarak nefroloji servisine ekterne edilmiþtir.
SONUÇLAR: Sonuç olarak metformin iliþkili laktik asidoz tanýsý konulan hastalarda ilk olarak düþünülmesi gereken tedavi yöntemi hemodiyaliz ve CVVHDF olmalýdýr. Hýzlý baþlanýlan ve yeterli süre devam edilen renal replasman tedavileri mortalite oraný yüksek olan bu tabloda umut vericidir. (SETB-2018-05-069)