A 61-year-old woman with a history of DM treated with metformin and glibenclamide came to the hospital for three days of vomiting and diarrhea, and on the day of admission abdominal pain.
Other medical history included hypertension, hypothyroidism and right knee replacement due to arthrosis.
The patient was under regular treatment with captopryl and levothyroxine.
During the 15 days prior to admission, the patient took several medications (diclofenac, NSAID and rofecoxib) for severe pain in the right knee.
Examination revealed normothermia, drowsiness, hyperventilation and dryness of mucous membranes.
Blood pressure was 169/81 mmHg, heart rate was 92 beats/minute and temperature was 36o C. Table 2 shows the main analytical data.
Metformin was discontinued and, since the administration of 425 mEq of bicarbonate barely improved gas (pH 6.97 and bicarbonate 4.9 mEq/l), a hemodialysis session was performed which increased pH 7.27.
Six days later, the patient was discharged with creatinine of 1.2 mg/dl and pH of 7.45.
