Metformin-associated lactic acidosis exacerbated by acute kidney injury in an overseas traveler
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Hayashi, Ayano
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Kitano Hosp, Tazuke Kofukai Med Res Inst, Dept Nephrol & Dialysis, Kita Ku, 2-4-20 Ohgimachi, Osaka 5308480, Japan
Kyoto Univ, Grad Sch Med, Dept Nephrol, Sakyo Ku, 54 Shogoin Kawahara Cho, Kyoto 6068507, JapanKitano Hosp, Tazuke Kofukai Med Res Inst, Dept Nephrol & Dialysis, Kita Ku, 2-4-20 Ohgimachi, Osaka 5308480, Japan
Hayashi, Ayano
[1
,2
]
Ishimura, Takuya
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Kitano Hosp, Tazuke Kofukai Med Res Inst, Dept Nephrol & Dialysis, Kita Ku, 2-4-20 Ohgimachi, Osaka 5308480, Japan
Kyoto Univ, Grad Sch Med, Dept Nephrol, Sakyo Ku, 54 Shogoin Kawahara Cho, Kyoto 6068507, JapanKitano Hosp, Tazuke Kofukai Med Res Inst, Dept Nephrol & Dialysis, Kita Ku, 2-4-20 Ohgimachi, Osaka 5308480, Japan
Ishimura, Takuya
[1
,2
]
Sugimoto, Hisashi
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Kitano Hosp, Tazuke Kofukai Med Res Inst, Dept Nephrol & Dialysis, Kita Ku, 2-4-20 Ohgimachi, Osaka 5308480, Japan
Kyoto Univ, Grad Sch Med, Dept Nephrol, Sakyo Ku, 54 Shogoin Kawahara Cho, Kyoto 6068507, JapanKitano Hosp, Tazuke Kofukai Med Res Inst, Dept Nephrol & Dialysis, Kita Ku, 2-4-20 Ohgimachi, Osaka 5308480, Japan
Sugimoto, Hisashi
[1
,2
]
Suzuki, Hiroyuki
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Kitano Hosp, Tazuke Kofukai Med Res Inst, Dept Nephrol & Dialysis, Kita Ku, 2-4-20 Ohgimachi, Osaka 5308480, Japan
Shonan Kamakura Gen Hosp, Kidney Dis & Transplant Ctr, Kamakura City, 1370-1 Okamoto, Kamakura, Kanagawa 2478533, JapanKitano Hosp, Tazuke Kofukai Med Res Inst, Dept Nephrol & Dialysis, Kita Ku, 2-4-20 Ohgimachi, Osaka 5308480, Japan
Suzuki, Hiroyuki
[1
,3
]
Hamasaki, Akihiro
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Kitano Hosp, Ctr Diabet & Endocrinol, Tazuke Kofukai Med Res Inst, Kita Ku, 2-4-20 Ohgimachi, Osaka 5308480, JapanKitano Hosp, Tazuke Kofukai Med Res Inst, Dept Nephrol & Dialysis, Kita Ku, 2-4-20 Ohgimachi, Osaka 5308480, Japan
Hamasaki, Akihiro
[4
]
Tsukamoto, Tatsuo
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Kitano Hosp, Tazuke Kofukai Med Res Inst, Dept Nephrol & Dialysis, Kita Ku, 2-4-20 Ohgimachi, Osaka 5308480, JapanKitano Hosp, Tazuke Kofukai Med Res Inst, Dept Nephrol & Dialysis, Kita Ku, 2-4-20 Ohgimachi, Osaka 5308480, Japan
Tsukamoto, Tatsuo
[1
]
机构:
[1] Kitano Hosp, Tazuke Kofukai Med Res Inst, Dept Nephrol & Dialysis, Kita Ku, 2-4-20 Ohgimachi, Osaka 5308480, Japan
[2] Kyoto Univ, Grad Sch Med, Dept Nephrol, Sakyo Ku, 54 Shogoin Kawahara Cho, Kyoto 6068507, Japan
[3] Shonan Kamakura Gen Hosp, Kidney Dis & Transplant Ctr, Kamakura City, 1370-1 Okamoto, Kamakura, Kanagawa 2478533, Japan
[4] Kitano Hosp, Ctr Diabet & Endocrinol, Tazuke Kofukai Med Res Inst, Kita Ku, 2-4-20 Ohgimachi, Osaka 5308480, Japan
We report the case of metformin-associated lactic acidosis (MALA) exacerbated by acute kidney injury (AKI) in a 65-year-old Asian American woman who was an overseas traveler. She had vomiting and diarrhea before arriving in Osaka, Japan, from the Philippines. She suffered from worsening respiratory distress, consciousness loss and anuria the day after coming to Japan. When she arrived at our emergency room via ambulance, she appeared to be in a state shock. Arterial blood gas analysis revealed severe lactic acidosis (pH 6.681, PO2 302 Torr under O-2 supplementation, PCO2 15 Torr, HCO(3)(-)1.7 mmol/L, and lactate 17.00 mmol/L). She also had renal failure (BUN 108 mg/dL and serum creatinine 8.68 mg/dL) with hyperkalemia (6.1 mEq/L). We collected medical information from family members, and found her prescription medicines including metformin, diuretics and angiotensin-converting enzyme inhibitor (ACEI). We diagnosed her with MALA due to an unintended overdose of metformin resulting from acute kidney injury that can be induced by ACEI and diuretics in the volume-depleted condition. We immediately started hemodialysis therapy. Although she had a temporary cardiopulmonary arrest at the beginning of the treatment, her physical status was gradually improved and the severe acidemia resolved. On hospital day 4, she had urine and no longer needed hemodialysis therapy. On day 14, she was discharged and returned to the United States without noticeable sequelae. This is a case report of an overseas traveler who was successfully rescued through the collection of accurate medical information and understanding of the pathological condition.
机构:
Northwell Hlth Long Isl Jewish Forest Hills Hosp, Internal Med, Forest Hills, NY 11375 USANorthwell Hlth Long Isl Jewish Forest Hills Hosp, Internal Med, Forest Hills, NY 11375 USA
Rai, Harpreet K.
Patel, Pranavkumar
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Northwell Hlth Long Isl Jewish Forest Hills Hosp, Internal Med, Forest Hills, NY 11375 USANorthwell Hlth Long Isl Jewish Forest Hills Hosp, Internal Med, Forest Hills, NY 11375 USA
Patel, Pranavkumar
Reddy, Kalpana
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Northwell Hlth Long Isl Jewish Forest Hills Hosp, Endocrinol, Forest Hills, NY USANorthwell Hlth Long Isl Jewish Forest Hills Hosp, Internal Med, Forest Hills, NY 11375 USA
机构:
Omdurman Islamic Univ, Fac Med Lab Sci, Dept Med Microbiol, Khartoum, Sudan
Sirius Training & Res Ctr, Mol Biol Unit, Khartoum, SudanUniv Gezira, Dept Internal Med, Gezira, Sudan
Azhary, Ayman
Hajhamed, Nooh Mohamed
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Omdurman Islamic Univ, Fac Med Lab Sci, Dept Med Microbiol, Khartoum, Sudan
Sirius Training & Res Ctr, Mol Biol Unit, Khartoum, SudanUniv Gezira, Dept Internal Med, Gezira, Sudan