Lactic Acidosis and Acute Kidney Injury Caused by Overdose of Metformin in a Patient With Type 2 Diabetes Mellitus

DOI
  • Watanabe Satoko
    Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital
  • Teshigawara Sanae
    Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital
  • Kunikata Yuria
    Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital
  • Mishima Maki
    Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital
  • Tahara Toshihisa
    Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital
  • Imai Yusuke
    Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital
  • Kaneto Mitsuhiro
    Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital
  • Tamura Tomokazu
    Department of Internal Medicine, Kidney Dialysis Center, Okayama Saiseikai General Hospital
  • Momoki Noriya
    Department of Internal Medicine, Kidney Dialysis Center, Okayama Saiseikai General Hospital
  • Kotake Kazumasa
    Department of Pharmacy, Okayama Saiseikai General Hospital
  • Tone Atsuhito
    Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital
  • Nakatou Tatsuaki
    Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital

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Other Title
  • メトホルミンの過量服薬により乳酸アシドーシスと急性腎不全を呈した2型糖尿病の1例

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<p>We herein report a case of type 2 diabetes mellitus with lactic acidosis and acute kidney injury triggered by an overdose of metformin. Two weeks before admission, a man in his 50s was depressed and had anorexia. He visited our hospital 2 days before admission and had a serum creatinine (sCr) level of 1.50 mg/dL, blood glucose level of 247 mg/dL, and normal blood gas analysis findings. A blood test performed at another hospital the day before admission revealed an sCr of 1.42 mg/dL. He took an estimated 4000 mg of metformin that night, and nausea, vomiting and diarrhea occurred. The next day, the patient was brought to the emergency department of our hospital by ambulance. A blood gas analysis and blood test revealed a pH of 6.91, lactate of 25 mmol/L and sCr of 4.39 mg/dL, showing lactic acidosis and acute renal failure. Emergency hemodialysis was performed, and his life was saved. A rapid deterioration of the renal function was observed after an overdose of metformin in addition to dehydration, suggesting direct renal damage due to metformin. Hemodialysis, which can remove lactic acid and metformin, was effective in treating lactic acidosis and acute renal failure.</p>

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