A case of metformin-associated lactic acidosis followed by Takotsubo cardiomyopathy

DOI 9 References
  • Jin Joo Woo
    Department of Emergency and Intensive Care Medicine, Otsu Municipal Hospital
  • Koogichi Kunihiko
    Department of Emergency and Intensive Care Medicine, Otsu Municipal Hospital
  • Fukui Michihiko
    Department of Emergency and Intensive Care Medicine, Otsu Municipal Hospital
  • Shinzato Taiichi
    Department of Emergency and Intensive Care Medicine, Otsu Municipal Hospital
  • Sakaguchi Masahiro
    Department of Emergency and Intensive Care Medicine, Otsu Municipal Hospital
  • Itagaki Naruhiko
    Department of Emergency and Intensive Care Medicine, Otsu Municipal Hospital
  • Inami Naoko
    Department of Emergency and Intensive Care Medicine, Otsu Municipal Hospital
  • Fujiwara Daisuke
    Department of Emergency and Intensive Care Medicine, Otsu Municipal Hospital

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Other Title
  • メトホルミンによる乳酸アシドーシスにたこつぼ心筋症を続発した1症例

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Abstract

We report a case of a 66-year-old woman who had metformin-associated lactic acidosis after overdosing of zolpidem tartrate. She displayed restlessness on admission to our emergency room. Blood gas analysis showed severe lactic acidosis and she was admitted to the ICU. After 9 hours, she complained of chest pain. Apical ballooning was observed on echocardiography, and Takotsubo cardiomyopathy was suspected. Her condition resolved, and on the 9th hospital day, she was discharged from the ICU. Lactic acidosis is a rare but sometimes fatal adverse effect of metformin. In this case, respiratory failure as a result of zolpidem tartrate overdose may have induced severe lactic acidosis, which is associated with metformin. The physical stress of lactic acidosis and the psychic stress which caused suicide attempt might eventually result in Takotsubo cardiomyopathy.

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