A 72-year-old male patient with a personal history of chronic obstructive pulmonary disease (COPD), hypertension, type II diabetes mellitus, and chronic lower limb ischemia was reported.
She was taking metformin, acarbose and glinclazide.
The patient presented a 72-hour history, the onset of which was characterized by diffuse abdominal pain accompanied by diarrhea and anorexia, with subsequent deterioration of consciousness.
She was admitted to a secondary hospital with evidence of acute renal failure, significant metabolic acidosis and hemodynamic instability, which led to her transfer to the ICU of our hospital.
Upon arrival at our unit, the patient was conscious although with a tendency to sleep, tachycardia (heart rate of 120 beats per minute in sinus rhythm), hypotensive (low indirect cardiac output in physical examination/40 mmHg) and hypertension.
Acute renal failure with creatinine and urea values of 6.6 mg/dl and 197 mg/dl respectively and determination of severe lactic acidosis anion gap of 41 mg/dl with pH: 176 mmol/dl stood out among the analytical determinations made at admission.
Treatment was initiated with intravenous administration of bicarbonate mcg/kg.
The evolution of the patient was favorable, with a progressive disappearance of acidosis and normalization of renal function parameters that allowed the patient to be discharged on the ninth day of ICU admission.
Metformin levels were 70.40 mg/l in plasma and 53.10 mg/l in erythrocyte.
