A Case of Type 2 Diabetes Mellitus with Severe Lactic Acidosis and Beriberi Heart Disease during the Administration of Low-dose Metformin

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  • Yamaguchi Hiroshi
    Department of Internal Medicine, Tokushima Prefectural Central Hospital
  • Iima Tsutomu
    Department of Internal Medicine, Tokushima Prefectural Central Hospital
  • Shirakami Atsuhisa
    Department of Internal Medicine, Tokushima Prefectural Central Hospital
  • Tamaki Motoyuki
    Department of Internal Medicine, Tokushima Prefectural Central Hospital
  • Sekimoto Etsuko
    Department of Internal Medicine, Tokushima Prefectural Central Hospital
  • Shibata Hironobu
    Department of Internal Medicine, Tokushima Prefectural Central Hospital
  • Okumura Takanobu
    Department of Cardiology, Tokushima Prefectural Central Hospital
  • Ozaki Shuji
    Department of Internal Medicine, Tokushima Prefectural Central Hospital
  • Shigekiyo Toshio
    Department of Internal Medicine, Tokushima Prefectural Central Hospital

Bibliographic Information

Other Title
  • 低用量メトホルミン投与中に乳酸アシドーシスと衝心脚気を合併した2型糖尿病の1例
  • 症例報告 低用量メトホルミン投与中に乳酸アシドーシスと衝心脚気を合併した2型糖尿病の1例
  • ショウレイ ホウコク テイヨウリョウ メトホルミン トウヨ チュウ ニ ニュウサン アシドーシス ト ショウシン カッケ オ ガッペイ シタ 2ガタ トウニョウビョウ ノ 1レイ

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A 69-year-old male who was being treated for type 2 diabetes mellitus with low-dose metformin was referred to our emergency department for an evaluation of a decreased level of consciousness due to shock. He had experienced nausea and appetite loss five days prior to admission followed by a fever three days prior to admission. Echocardiography showed marked right-sided dilatation and elevation of estimated systolic pulmonary artery pressure. Contrast-enhanced computed tomography demonstrated no findings of pulmonary artery thromboembolism. A blood examination disclosed an elevated serum lactic acid level (118.0 mg/dl). Beriberi heart disease was diagnosed as the cause of the patient's severe pulmonary hypertension, as it was later found that the thiamine level on admission was below the lower limit of normal (2.2 μg/dl). Although anti-IA-2 antibodies were positive at a low titer, anti-GAD antibodies were negative. Therefore, the patient was diagnosed with type 2 diabetes mellitus. The lactic acidosis was considered to be caused by the combined etiology of the deficiency of thiamine, cardiogenic shock and side effects of metformin. Gastrointestinal symptoms as the side effects of low-dose metformin served as a trigger for the development of lactic acidosis. Therefore, when side effects of metformin are a concern, it is necessary to immediately discontinue metformin treatment in order to prevent lactic acidosis.

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