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2025, Number 2

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Med Crit 2025; 39 (2)

Metformin-induced lactic acidosis in a patient with chronic kidney disease

Sánchez GJI, Campos CP, Báez CN

Language: Spanish
References: 14
Page: 154-158
PDF size: 618.21 Kb.


ABSTRACT

Metformin is one of the most commonly used first-line treatments for type 2 diabetes, due to its efficacy, low cost, and minimal risk of hypoglycemia. Nevertheless, in patients with risk factors such as hepatic failure, cardiac dysfunction, or advanced chronic kidney disease, its use may be associated with lactic acidosis, a potentially life-threatening complication. We present the case of a woman with a history of stage V chronic kidney disease secondary to lupus nephropathy, who developed metabolic acidosis with hyperlactatemia following accidental ingestion of metformin. The patient presented with altered mental status and severe acidosis documented on arterial blood gas analysis. In view of severe metabolic acidosis refractory to treatment, she underwent emergency hemodialysis, in addition to admission to the intensive care unit for close monitoring. The patient showed progressive clinical and metabolic improvement after renal replacement therapy. The objective of this case is to emphasize the importance of timely recognition and management of metformin-induced lactic acidosis, particularly in patients with severely impaired renal function, a condition that may go unnoticed in hospital settings.


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