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Lam N, Sekhon G, House AA. Metformin-Associated Lactic Acidosis following Intentional Overdose Successfully Treated with Tris-Hydroxymethyl Aminomethane and Renal Replacement Therapy. Case Rep Nephrol. 2012;2012:671595doi: 10.1155/2012/671595.
Lam, N., Sekhon, G., & House, A. A. (2012). Metformin-Associated Lactic Acidosis following Intentional Overdose Successfully Treated with Tris-Hydroxymethyl Aminomethane and Renal Replacement Therapy. Case reports in nephrology, 2012671595. https://doi.org/10.1155/2012/671595
Lam, Ngan, et al. "Metformin-Associated Lactic Acidosis following Intentional Overdose Successfully Treated with Tris-Hydroxymethyl Aminomethane and Renal Replacement Therapy." Case reports in nephrology vol. 2012 (2012): 671595. doi: https://doi.org/10.1155/2012/671595
Lam N, Sekhon G, House AA. Metformin-Associated Lactic Acidosis following Intentional Overdose Successfully Treated with Tris-Hydroxymethyl Aminomethane and Renal Replacement Therapy. Case Rep Nephrol. 2012;2012:671595. doi: 10.1155/2012/671595. Epub 2012 May 23. PMID: 24533205; PMCID: PMC3914246.
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Case Rep Nephrol. 2012;2012:671595. doi: 10.1155/2012/671595. Epub 2012 May 23.

Metformin-Associated Lactic Acidosis following Intentional Overdose Successfully Treated with Tris-Hydroxymethyl Aminomethane and Renal Replacement Therapy.

Case reports in nephrology

Ngan Lam, Gurbir Sekhon, Andrew A House

Affiliations

  1. Division of Nephrology, Department of Medicine, Western University, London, ON, Canada N6A 3K7 ; London Health Sciences Centre, Kidney Clinical Research Unit, Victoria Hospital, Westminster Tower 800 Commissioners Road East, London, ON, Canada N6A 4G5.
  2. Department of Medicine, Western University, London, ON, Canada N6A 3K7.
  3. Division of Nephrology, Department of Medicine, Western University, London, ON, Canada N6A 3K7 ; Department of Medicine, Western University, London, ON, Canada N6A 3K7.

PMID: 24533205 PMCID: PMC3914246 DOI: 10.1155/2012/671595

Abstract

A 43-year-old woman was brought to the hospital with severe metabolic acidosis (pH 6.56, bicarbonate 3 mmol/L, and lactate 18.4 mmol/L) and a serum creatinine of 162 μmol/L with a serum potassium of 7.8 mmol/L. A delayed diagnosis of metformin-associated lactic acidosis was made, and she was treated with tris-hydroxymethyl aminomethane (THAM) and renal replacement therapy (RRT). Following a complete recovery, she admitted to ingesting 180 tablets (90 grams) of metformin. Her peak serum metformin concentration was 170 μg/mL (therapeutic range 1-2 μg/mL). Our case demonstrates an intentional metformin overdose resulting in lactic acidosis in a nondiabetic patient who was successfully treated with THAM and RRT.

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