TY - JOUR
T1 - Surviving cardiac arrest from severe metformin-associated lactic acidosis using extracorporeal membrane oxygenation and double continuous venovenous haemodialysis
AU - Akkaoui, Kirstine Krushave
AU - Andersen, Ljubica Vukelic
AU - Nørgaard, Martin Agge
AU - Andreasen, Jo Bønding
N1 - © BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/8/16
Y1 - 2023/8/16
N2 - 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.
AB - 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.
KW - Acidosis, Lactic/chemically induced
KW - Continuous Renal Replacement Therapy
KW - Extracorporeal Membrane Oxygenation
KW - Heart Arrest/chemically induced
KW - Humans
KW - Male
KW - Metformin/adverse effects
KW - Cardiovascular medicine
KW - Fluid electrolyte and acid-base disturbances
KW - Dialysis
KW - Adult intensive care
KW - Resuscitation
UR - http://www.scopus.com/inward/record.url?scp=85168235815&partnerID=8YFLogxK
U2 - 10.1136/bcr-2023-254649
DO - 10.1136/bcr-2023-254649
M3 - Journal article
C2 - 37586755
SN - 1757-790X
VL - 16
JO - BMJ Case Reports
JF - BMJ Case Reports
IS - 8
M1 - e254649
ER -