Uncommon and forgotten drug-induced lactic acidosis: a case report

Roberto R. Gutiérrez-Gómez, Department of Nephrology, Hospital de Especialidades Guayaquil Dr. Abel Gilbert Pontón, Guayaquil, Ecuador
Dixiana Y. García-Sánchez, Nephrology Postgraduate Program, Postgraduate Faculty, Universidad Educativa Espíritu Santo, Guayaquil, Ecuador
Valeria L. Segarra-Zambrano, Critical Care Medicine Postgraduate Program, Postgraduate Faculty, Universidad Educativa Espíritu Santo, Guayaquil, Ecuador
Julexi F. Vaca-Romero, School of Health Sciences and Human Development, Ecotec University. Guayaquil, Ecuador

Metabolic acidosis is a common disorder of the internal environment with diverse causes. Among these causes, drug overdose and poisoning represent a less common group; however, they are associated with high severity and mortality. A female patient with a history of major depression. She presented with abdominal pain accompanied by vomiting, dyspnea, and pallor following ingestion of metformin in the context of a suicide attempt. Laboratory tests revealed metabolic acidosis with an elevated anion gap, attributed primarily to lactic acidosis. Given the suspicion of lactic acidosis secondary to metformin poisoning, prolonged intermittent hemodialysis was indicated. Lactic acidosis secondary to metformin poisoning is a medical emergency with a high potential for mortality that requires a high index of clinical suspicion, especially in patients with a psychiatric history and a risk of intentional drug ingestion. Intensive management, including early hemodialysis, is essential for drug elimination and correction of acid-base imbalance, which contributes to improved prognosis.

Keywords: Poisoning. Hemodialysis. Metformin. Lactic acidosis. Metabolic acidosis.