A 72-year-old woman with DM-2, hypertension and ischemic heart disease was treated with metformin (850 mg/12 hours), enalapril (5 mg/day), furosemide (20 mg/day), acetylsalicylic acid (20 mg/day).
He came to the hospital emergency department due to vomiting of one week of evolution, without fever, associated in the last four days to pain in the lower limbs, weakness and diffuse abdominal discomfort.
Ambulate was treated with diclofenac and metoclopramide, and this treatment was followed by liquid deposition and oliguria.
On physical examination, the patient was conscious, afflicted, her blood pressure was 80/50 mmHg and her oxygen saturation by pulse oximetry was 97%.
He had tachypnea (25 breaths/minute), and both cardiopulmonary auscultation and abdominal palpation were normal.
Blood tests showed a non-baseline glucose of 347 mg/dL (70-110), urea: 160 mg/dL (13-71), creatinine: 4.38 mg/dL (0.50-0.90), sodium: 176 mmol/dL
Lactadehydrogenase, creatine kinase, amylase, calcium, magnesium, blood count and coagulation were normal.
Two hemocultives and one coprocultive were negative.
Metformin level by high performance liquid chromatography was 43 mg/L (therapeutic values: 0.1-1.3 mg/L and toxic: 5-10 mg/L).
The electrocardiogram showed widening of the QRS complex and flattening of the P wave. Chest X-ray and abdominal ultrasound showed no abnormalities.
Treatment was established with intravenous volume replacement, bicarbonate, nebulized salbutamol and glucose with insulin to correct hyperkalemia.
Since the patient was still hypotensive and in anuria, noradrenaline infusion (0.5 μg/kg/min) was initiated and the patient was referred to the Intensive Care Unit.
Hemodialysis was performed there and her clinical situation improved rapidly, the renal function and the hydroelectrolytic alterations progressively normalized, and the LA reverted.
