Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

01.09.2017 | case report | Ausgabe 17-18/2017 Open Access

Wiener klinische Wochenschrift 17-18/2017

Combined metformin-associated lactic acidosis and euglycemic ketoacidosis

Zeitschrift:
Wiener klinische Wochenschrift > Ausgabe 17-18/2017
Autoren:
Verena Schwetz, Florian Eisner, Gernot Schilcher, Kathrin Eller, Johannes Plank, Alice Lind, Thomas R. Pieber, Julia K. Mader, Philipp Eller
Wichtige Hinweise
Author contributions
V. Schwetz, J.K. Mader, P. Eller collected data, interpreted data and drafted the manuscript. F. Eisner, G. Schilcher, K. Eller, J. Plank, A. Lind, T.R. Pieber interpreted data, contributed to discussions, and critically revised the manuscript. All authors approved the final version of the manuscript. P. Eller is the guarantor of this work.

Summary

Background

In renal failure metformin can lead to lactic acidosis. Additional inhibition of hepatic gluconeogenesis by accumulation of the drug may aggravate fasting-induced ketoacidosis. We report the occurrence of metformin-associated lactic acidosis (MALA) with concurrent euglycemic ketoacidosis (MALKA) in three patients with renal failure.

Case presentations

Patient 1: a 78-year-old woman (pH = 6.89, lactic acid 22 mmol/l, serum ketoacids 7.4 mmol/l and blood glucose 63 mg/dl) on metformin and insulin treatment. Patient 2: a 79-year-old woman on metformin treatment (pH = 6.80, lactic acid 14.7 mmol/l, serum ketoacids 6.4 mmol/l and blood glucose 76 mg/dl). Patient 3: a 71-year-old man on metformin, canagliflozin and liraglutide treatment (pH = 7.21, lactic acid 5.9 mmol/l, serum ketoacids 16 mmol/l and blood glucose 150 mg/dl). In all patients, ketoacidosis receded on glucose infusion and renal replacement therapy.

Conclusion

This case series highlights the parallel occurrence of MALA and euglycemic ketoacidosis, the latter exceeding ketosis due to starvation, suggesting a metformin-triggered inhibition of gluconeogenesis. Affected patients benefit from glucose infusion counteracting suppressed hepatic gluconeogenesis.
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 17-18/2017

Wiener klinische Wochenschrift 17-18/2017 Zur Ausgabe

mitteilungen der gesellschaft der ärzte in wien

Veranstaltungen