Wagle Laxman, Regmi Dhiraj R, Regmi Rashmita, Poudel Sishir, Pant Hom Nath
Internal Medicine, Ascension Saint Agnes Hospital, Baltimore, USA.
Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, NPL.
Cureus. 2024 Jun 25;16(6):e63130. doi: 10.7759/cureus.63130. eCollection 2024 Jun.
Metformin is a widely prescribed, oral, anti-diabetic agent for the treatment of type 2 diabetes mellitus (DM2). While generally well-tolerated, metformin can accumulate in patients with acute kidney injury (AKI) or chronic kidney disease (CKD), leading to potentially life-threatening complications such as metformin-associated lactic acidosis (MALA). Severe hyperkalemia is a rare but serious manifestation of metformin toxicity. We report a case of a 74-year-old African American man with DM2, hypertension, and CKD stage 3a, who presented with nausea, vomiting, lethargy, and diarrhea. Laboratory findings revealed severe AKI with a creatinine level of 8 mg/dL (baseline 1.7 mg/dL) and a potassium level of 7.8 mEq/L. The patient developed refractory hyperkalemia requiring multiple interventions and eventually continuous renal replacement therapy. Further evaluation revealed metformin-induced severe lactic acidosis with a metformin level of 21 mcg/mL (therapeutic range <5 mcg/mL). This case highlights the importance of recognizing metformin toxicity as a potential cause of severe, refractory hyperkalemia and metabolic acidosis in patients with AKI or CKD. Early recognition and prompt discontinuation of metformin, along with appropriate management of electrolyte disturbances and metabolic derangements, are crucial in preventing life-threatening complications.
二甲双胍是一种广泛处方的口服抗糖尿病药物，用于治疗2型糖尿病（DM2）。虽然通常耐受性良好，但二甲双胍可在急性肾损伤（AKI）或慢性肾脏病（CKD）患者体内蓄积，导致诸如二甲双胍相关乳酸酸中毒（MALA）等潜在危及生命的并发症。严重高钾血症是二甲双胍毒性的一种罕见但严重的表现。我们报告一例74岁非裔美国男性患者，患有DM2、高血压和3a期CKD，出现恶心、呕吐、嗜睡和腹泻。实验室检查发现严重AKI，肌酐水平为8mg/dL（基线值1.7mg/dL），钾水平为7.8mEq/L。患者出现难治性高钾血症，需要多次干预，最终接受连续性肾脏替代治疗。进一步评估发现二甲双胍诱发严重乳酸酸中毒，二甲双胍水平为21mcg/mL（治疗范围<5mcg/mL）。该病例强调了认识到二甲双胍毒性是AKI或CKD患者严重难治性高钾血症和代谢性酸中毒潜在原因的重要性。早期识别并及时停用二甲双胍，以及对电解质紊乱和代谢紊乱进行适当处理，对于预防危及生命的并发症至关重要。
