Acute renal failure and lactic acidosis seconder to metformin intoxication

Abstract

Metformin is a oral antidiabetic drug being class of biguanid. It reduces hepatic glucose production by inhibiting gluconeogenesis, improves peripheral insulin sensivity. The well known serious side effects are acute renal failure and lactic asidosis. Metformin is the most commonly prescribed drug because of its cost-effectiveness and existing in first line theraphy in guidelines for type 2 diabetes mellitus. We report a case a patient with known hypertension and new diagnosis diabetes mellitus, presenting acute renal failure and lactic acidosis seconder to taking overdose metformin in suicide attempt.

Keywords

• Metformin intoxication
• acute renal failure
• lactic acidosis

Metformin intoksikasyonuna sekonder gelişen akut böbrek hasarı ve laktik asidoz

Abstract

Metformin biguanid sınıfına ait bir oral antidiyabetik ajandır. Hepatik glukoneogenezi inhibe ederek glukoz üretimini azaltır; periferal dokularda insulin duyarlılığını düzeltir. Bilinen en korkulan yan etkisi laktik asidoz ve akut böbrek hasarıdır. Metformin gerek ucuz olması gerek ise diyabet tedavi kılavuzlarında ilk sıralarda yer alması nedeniyle diyabet tanılı hastalarda oldukça sık kullanılan bir ilaçtır. Bu olgu sunusunda bilinen hipertansif bir hastada yeni diyabet tanısı ile metformin tedavisine başlanmasından bir kaç ay sonra intihar amaçlı yüksek doz metformin alımına sekonder gelişen laktik asidoz ve akut böbrek hasarlı bir olgu anlatılmaktadır.

Keywords

• Metformin intoksikasyonu
• akut böbrek hasarı
• laktik asidoz

References

1. 1-Momenzadeh M, Lakkakuka B.VKS. Metformin induced acute kidney injury; a systematic review. J. Nephropharmacol 2021; 10(2): 13. https://doi.10.34172/npj.2021.13.
2. 2- Corremans R, Vervaet B.A, D’haese P.C., Neven E, Verhulst A. Metformin: A candidate drug for renal diseases. Int J Mol Sci 2019; 20: 42. https://doi.10.3390/ijms20010042.
3. 3- Lashen H. Role of metformin in the management of polycystic ovary syndrome. Ther Adv Endocrinol. Metab 2010; 1: 117-128. https://doi. 10.1177/2042018810380215.
4. 4- Li YAN, Liu LEI, Wang BIN, Wang JUN, Chen D. metformin in non-alcoholic fatty liver disease: A systematic review and meta-analysis. Biomed Rep 2013; 1: 57-64.https://doi: 10.3892/br.2012.18.
5. 5- Ibanez L, Ong K, Valls C, Marcos MV, Dunger DB, De Zegher F. Metformin treatment to prevent early puberty in girls with precocious pubarche. J Clin Endocrinol Metab 2006;91: 2888-2891. https:// doi: 10.1210/jc.2006-0336.
6. 6- DeFronzo R, Fleming GA, Chen K, Bicsak TA. Metformin-associated lactic acidosis: current perspectives on causes and risk. Metabolism Clinical and Experimental 2016; 65: 20-29. https:// doi: 10.1016/j.metabol.2015.10.014
7. 7- Chan NN, Brain HP, Feher MD. Metformin-associated lactic acidosis: a rare or very rare clinical entity? Diabet Med 1999; 16: 273-281. https:// doi: 10.1046/j.1464-5491.1999.00006.x.
8. 8- Inzucchi SE, Lipska KJ, Mayo H, Bailey CJ, McGuire DK. Metformin in patients with Type 2 Diabetes and Kidney Disease: A systematic Review. JAMA 2014: 312(24): 2668-2675. https:// doi: 10.1001/jama.2014.15298.

9. 9- Angioi A, Cabiddu G, Conti M, et al. Metformin associated lactic acidosis: a case series of 28 patients treated with sustained low-efficiency dialysis (SLED) and long-term follow-up. BMC Nephrology 2018; 19: 77. https:// doi: 10.1186/s12882-018-0875-8.
10. 10- Kinoshita H, Yanai M, Ariyoshi K, Ando M, Tamura R. A patients with metformin-associated lactic acidosis successfully treated with continuous renal replacement theraphy: a case report. Journal of Medical Case Reports 2019; 13: 371. https:// doi: 10.1186/s13256-019-2311-5.
11. 11- Arroyo D, Melero R, Panizo N, et al. Metformin-associated acute kidney injury and lactic acidosis. Int. J. of Nephrology 2011;2011:5. https://doi:10.4061/2011/749653
12. 12- Kocaoğlu Ç, Özel A. Metformin intoksikasyonuna bağlı akut böbrek yetmezliği: olgu sunumu. J Turk Soc Intensive Care 2018; 16: 76-78. https:// doi: 10.4274/tybd.26818