Early initiation of continuous renal replacement therapy for metformin-associated lactic acidosis

Abstract

Introduction Rapid diagnosis of metformin-associated lactic acidosis (MALA) and initiation of continuous renal replacement therapy (CRRT) in diabetic patient successfully corrects a severe metabolic disorder of a patient with acute renal failure.

Case outline A 58-year-old male patient with a medical history of type 2 diabetes and alcohol abuse was admitted to the Emergency Department because of vomiting, diarrhea, and altered mental status. Initial arterial blood gas analysis revealed severe metabolic acidosis (pH: 6.8, PaCO2: 12 mmHg, HCO3: 3.2 mmol/l), but the lactate level was too high to measure. MALA was suspected based on progressive lactic acidosis and past intake of metformin. Renal replacement therapy was initiated – continuous veno–venous hemodiafiltration, and as a result a significant improvement of the clinical status, with both blood pH and lactate level showing normalization, was achieved after finishing CRRT.

Conclusion MALA carries an ominous prognosis. This case suggests early initiation of CRRT in hemodynamically unstable diabetic patients with MALA.

Keywords: MALA; acute kidney injury; dialysis; lactic acidosis