A 68-year-old male with a history of DM treated with metformin was admitted to hospital due to chest pain secondary to acute myocardial infarction.
Three days later, the patient was treated with diltiazen, aspirin and enoxaparin.
Six days later she was discharged on treatment with metformin (850 mg/12 h), torasemide, nitroglycerin and trimetazidine.
Eight days later, without stopping metformin, a coronary angiography was performed at the referral hospital, which showed a single lesion in the circumflex artery, and a stent was placed.
Then, without serum creatinine control post-catheterization, metformin was resumed.
He was also treated with aspirin, clopidogrel, ramiprile, diltiazen and glibenclamide.
Five days after catheterization, the patient returned to our hospital complaining of diffuse abdominal pain, nausea, vomiting, dyspnea, chest pain and anuria.
Blood pressure was 115/60 mmHg, temperature was 36.5oC and heart rate was 80 beats/minute.
Cardiac enzymes were normal, and the most significant analytical data are shown in Table 2.
The patient was diagnosed with acute renal failure secondary to contrast agents and received treatment with volume and bicarbonate.
As this treatment did not improve the clinical situation, a hemodialysis session was started, during which he suffered a cardiac arrest due to ventricular asystole.
Resuscitated by the intensive care physician, the patient died with the added diagnosis of metformin poisoning.
