Acidosis láctica y metformina. Tratamiento combinado con hemodiálisis y hemofiltración

We report a case of severe lactic acidosis dueto metformin ingestion in a 61-year-old woman with diabetes mellitus who continued taking metformin despite fasting for a week due to food intolerance and vomiting. The patient showed severe lactic acidosis (arterial pH 7.03, bicarbonate 3.6 mEq/l, lactate 18.58 mEq/l) and acute renal failure (urea 17.9 mmol/l, creatinine 634 μmol/l, Na+ 144 mmol/l, K+ 5.7 mmol/l). Despite hemodialysis and intravenous bicarbonate therapy, the patient required continuous hemodiafiltration for 16 hours. Outcome was favorable. Metformin-induced lactic acidosis is associated with a high mortality rate. Early renal replacement therapy should be considered as the main emergency treatment in these cases.