A 77-year-old man presented to the hospital with progressive deterioration of his general condition, dyspnea and anuria after a two-day diarrheal episode.
Her history included DM, hypertension, chronic bronchitis, dyslipidemia, allergy to penicillin and acute pancreatitis two years earlier.
He was under regular treatment with metformin (850 mg/8h) and glycazide, nebivolol, tamsulosin, metamizole and paracetamol.
Three weeks before admission, due to an episode of urinary retention and decreased strength in urinary retention, she was diagnosed with prostate cancer with disseminated metastases, including bone metastases in lumbar vertebrae.
Upon admission, the patient was conscious, tachypneic, with intercostal retraction and central and peripheral tape.
Blood pressure was 135/85 mmHg, heart rate was 90 beats/minute and the temperature was 36o C. Examination revealed a painful abdomen, a palpable bladder balloon and marked weakness of the lower extremities.
The most significant analytical data are shown in Table 2.
A urinary catheter was placed in 1.5.
The patient was diagnosed with neurogenic bladder due to spinal cord compression and metformin poisoning.
While emergency hemodialysis was being prepared, intravenous administration of calcium gluconate and sodium bicarbonate (500 mEq) decreased serum potassium to 6.6 mEq/l and increased pH to 7.13.
A hemodialysis session partially corrected blood gas deterioration (pH 7.36 and bicarbonate 9.6 mEq/l) and reduced potassium levels to 5.4 mEq/l and creatinine to 7.6 mg/dl after hemodialysis.
Seven days later the patient was discharged home with a creatinine level of 1 mg/dl and a pH of 7.4.
