A fatal autopsy case of metformin-associated lactic acidosis and respiratory failure with proven high plasma metformin concentration

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  • Totsuka Ryo
    Department of Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital
  • Suzuki Hidetaka
    Department of Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital
  • Aihara Fumiko
    Department of Pharmacy, Japanese Red Cross Musashino Hospital
  • Sakurai Urara
    Department of Pathology, Japanese Red Cross Musashino Hospital
  • Matsuo Kazuhiro
    Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University
  • Teraoka Mari
    Department of Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital
  • Hara Shunsuke
    Department of Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital
  • Harada Naoshige
    Department of Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital

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  • 乳酸アシドーシスと呼吸不全で死亡し，血漿メトホルミン濃度の著明高値が証明された一剖検例

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Abstract

<p>Metformin-associated lactic acidosis (MALA) is well known; however, only few studies have performed the blood concentration measurement of MALA and autopsy. We report a fatal autopsy case of MALA and respiratory failure wherein the plasma metformin concentration (PMC) was notably high. A 64-year-old female presented to our department with vomiting and was prescribed metformin for diabetes. She was admitted to the ICU after a diagnosis of MALA, acute kidney injury, and pneumonia. She died despite antibiotic administration, mechanical ventilation, and renal replacement therapy. Her PMC was remarkably elevated to 51.9 mg/L. Autopsy confirmed the presence of focal fusion pneumonia, but any specific cause of lactic acidosis was not found. This is a very rare case wherein both PMC measurement and autopsy were performed. Accumulation of PMC and clinical features are important for diagnosing MALA. Further reports and investigation are required to confirm whether specific pathological findings of MALA exist.</p>

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