Lactic Asidosis after Metformin Use in a Chronic Hemodialysis Patient

Metformin is a biguanide and is used especially in metabolic syndrome where insulin resistance is at the forefront and in Type 2 diabetes mellitus, both by suppressing the endogenous glucose production in the liver and increasing the sensitivity of insulin in peripheral tissues such as fat and muscle tissue (1). The most rare but life-threatening side effect of metformin is the development of lactic acidosis. Therefore, the glomerular filtration rate is 30 ml/min. its use is contraindicated in patients with chronic kidney disease (2). Lactic acidosis is the cause of metabolic acidosis with increased anion gap; occurs when the plasma lactate concentration exceeds 4-5 millimol/Liter (mmol/L) (Normal range: 0.5-1.5 mmol/L) (3). Here, we present the development of lactic acidosis due to metformin use in an 84-year-old female patient who has been on chronic hemodialysis treatment for 4 months. The patient applied to the emergency department twice because of confusion. The patient, who was found to have acidosis in the blood gas, regained consciousness after he was taken to hemodialysis and was referred to the nephrology outpatient clinic, considering that she might have dialysis insufficiency. The patient, who learned that she used metformin in his anamnesis, did not recur after the drug was stopped. The use of metformin in advanced age and renal failure may cause fatal complications. Glomerular filtration rate 45 ml/min. metformin should be used with caution in patients with should not be given to those below.