Work

Life-Threatening Metformin-Induced Lactic Acidosis Associated With Euglycemic Ketoacidosis and Acute Multiorgan Dysfunction: A Case Report

Year: 2025

Type: article

Abstract: Metformin-associated lactic acidosis (MALA) is a rare but life-threatening complication of metformin therapy. We present a case of a 63-year-old female with type 2 diabetes mellitus (on metformin and insulin) who developed severe lactic acidosis, euglycemic diabetic ketoacidosis (DKA), and acute kidney injury (AKI) following a three-day history of gastrointestinal symptoms. Despite initial stabilization efforts, the patient deteriorated into refractory shock and cardiac arrest, requiring intensive care unit (ICU) admission, continuous venovenous hemodiafiltration (CVVHD), vasopressor support, and mechanical ventilation. Serial arterial blood gas (ABG) analyses demonstrated profound metabolic acidosis (pH 6.77, lactate 20 mmol/L) with gradual normalization following CVVHD. The patient recovered fully, highlighting the importance of early recognition and aggressive management of MALA, including renal replacement therapy (RRT), in critically ill patients.

Source: Cureus

DOI: 10.7759/cureus.82717

Authors: Karim S Hussein, Rashid Nadeem, Ahmad Nabil

Institutions: Dubai Hospital, Ain Shams University

Language: English

Topic: Diabetes Treatment and Management

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4409643033