Abstract
Metformin-associated lactic acidosis (MALA) is a serious condition with high mortality. This case describes a man in the mid-60s with diabetes mellitus type 2 treated with metformin developing MALA 4 days after coronary stenting for non-ST-elevation myocardial infarction. He presented acutely with severe abdominal pain, a lactate of 19 mmol/L and pH 6.74. Despite treatment for MALA, he went into refractory cardiac arrest and was connected to venoarterial extracorporeal membrane oxygenation (VA-ECMO). He suffered a massive haemothorax due to perforation of the right atrial appendage. It was repaired through a sternotomy while being given massive blood transfusions. The following days, he was on VA-ECMO and double continuous venovenous haemodialysis (CVVHD). He survived with only mild paresis of the left hand. VA-ECMO should be considered a rescue therapy alongside treatment with CVVHD in case of cardiac arrest due to severe MALA.
Original language | English |
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Article number | e254649 |
Journal | BMJ Case Reports |
Volume | 16 |
Issue number | 8 |
ISSN | 1757-790X |
DOIs | |
Publication status | Published - 16 Aug 2023 |
Bibliographical note
© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.Keywords
- Acidosis, Lactic/chemically induced
- Continuous Renal Replacement Therapy
- Extracorporeal Membrane Oxygenation
- Heart Arrest/chemically induced
- Humans
- Male
- Metformin/adverse effects
- Cardiovascular medicine
- Fluid electrolyte and acid-base disturbances
- Dialysis
- Adult intensive care
- Resuscitation