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Severe lactic acidosis with euglycemic diabetic ketoacidosis due to metformin overdose. | LitMetric

AI Article Synopsis

  • - Metformin overdose can lead to serious complications, including both lactic acidosis and a rare condition called euglycemic diabetic ketoacidosis (euDKA), as shown in a case involving a 57-year-old woman who overdosed on her diabetes medication.
  • - The patient presented with severe metabolic acidosis and kidney injury shortly after taking an overdose of metformin and vildagliptin, resulting in elevated serum lactate levels and, later, increased ketone bodies despite stable blood glucose levels.
  • - The findings suggest that metformin overdose may cause metabolic acidosis through both lactic acidosis and euDKA, influenced by factors such as the patient's diabetes, starvation, and physiological stressors.

Article Abstract

Metformin-associated lactic acidosis is a well-known metformin treatment complication; however, the development of euglycemic diabetic ketoacidosis (euDKA) has rarely been reported. Here we report a case of lactic acidosis and euDKA after metformin overdose. A 57-year-old female patient was transferred to our hospital with severe metabolic acidosis and acute kidney injury. She had type 2 diabetes mellitus and was on oral antidiabetic therapy of vildagliptin metformin hydrochloride daily. On the admission day, she had committed suicide by overdosing 50 tablets of vildagliptin metformin hydrochloride, which was equivalent to 25,000 mg of metformin and 2500 mg of vildagliptin. She had severe lactic acidosis 5 h after overdosing. However, after 34 h of overdosing, serum lactate levels decreased while serum anion gap levels increased. She received single hemodialysis treatment. Serum total ketone bodies, β-hydroxybutyrate acetoacetic acid, and acetone were increased even after hemodialysis treatment. Her blood glucose levels have never exceeded 250 mg/dL since admission. Therefore, we considered that the cause of metabolic acidosis in this patient was not only lactic acidosis but also euDKA. The causes of euDKA in our patient might be hepatic production of ketone bodies due to metformin overdose in addition to type 2 diabetes mellitus, starvation, infection, and stressful physical conditions such as vomiting and diarrhea. We propose that not only lactic acidosis but also ketoacidosis is one of the important pathological conditions in patients with metformin overdose.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10620342PMC
http://dx.doi.org/10.1007/s13730-023-00783-wDOI Listing

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