RARE CASE OF LIFE-THREATENING METFORMIN-ASSOCIATED ACIDOSIS WITHOUT HYPERLACTATEMIA IN POSTOPERATIVE PERIOD

Anamaria Cotae; Oana Melente; Magdalena Costache; Maria Mierloiu; Cristian Cobilinschi; Radu Țincu; Ioana Grințescu

doi:10.33695/rjcr.v4i2.80

Anamaria Cotae Department of Anaesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania & Department of Anaesthesiology and Intensive Care, Bucharest Clinical Emergency Hospital, Intensive Care Unit, Romania
Oana Melente Department of Anaesthesiology and Intensive Care, Bucharest Clinical Emergency Hospital, Intensive Care Unit, Romania
Magdalena Costache Department of Anaesthesiology and Intensive Care, Bucharest Clinical Emergency Hospital, Intensive Care Unit, Romania
Maria Mierloiu Department of Anaesthesiology and Intensive Care, Bucharest Clinical Emergency Hospital, Intensive Care Unit, Romania
Cristian Cobilinschi Department of Anaesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania & Department of Anaesthesiology and Intensive Care, Bucharest Clinical Emergency Hospital, Intensive Care Unit, Romania
Radu Țincu Department of Toxicology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania & Department of Anaesthesiology and Intensive Care - Toxicology, Bucharest Clinical Emergency Hospital, Intensive Care Unit, Romania
Ioana Grințescu Department of Anaesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania & Department of Anaesthesiology and Intensive Care, Bucharest Clinical Emergency Hospital, Intensive Care Unit, Romania

DOI: https://doi.org/10.33695/rjcr.v4i2.80

Keywords: metformin, lactic acidosis, type 2 diabetes mellitus, normal lactate

Abstract

Metformin belongs to the biguanide class and is used in lowering serum glucose levels in diabetic patients. Metformin-associated lactic acidosis (MALA) is a severe and potentially fatal complication. The aim of this article is to emphasize the importance of early symptom recognition and prevention measures in patients on metformin. We report the case of a 90-year-old female patient admitted for major orthopedic surgery who developed MALA but with normal lactate levels post-intervention due to escalating renal impairment in the context of surgical stress. Intoxication was promptly resolved with fast-responding intravenous bicarbonate. If not adequately managed, MALA can be avoided if systemic drug exposure is limited in patients at risk. Rational administration of metformin should be implemented, knowing it currently belongs to the first-line therapeutical options in diabetic patients.

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