Affiliation:
1. the First Affiliated Hospital of Kunming Medical University
Abstract
Abstract
Background: Metformin is commonly used for the treatment of type 2 diabetes mellitus. It has multiple advantages, including low risk for hypoglycemia, weight neutrality, low cost, and cardioprotective and anti-inflammatory effects. However, renal insufficiency is one of the contraindications for its use. Inadvertent prescription in patients with renal insufficiency may lead to metformin-associated lactic acidosis (MALA), which is associated with a high risk of mortality. Consequently, the early recognition and management of MALA is essential.
Case Report: We present the case of a 58-year-old woman with history of type 2 diabetes mellitus with nephropathy and heart disease for which she was treated with metformin, insulin and other medicines for heart disease. She developed nausea, vomiting, anion gap metabolic acidosis due to hyperlactatemia, and acute kidney injury. She was hospitalized for i.v. hydration and correction of metabolic acidosis after she suddenly developed blindness. The diagnostic work-up ruled out central causes and her symptoms resolved briefly after continuous vein-vein hemodialysis (CVVHD) was initiated, confirming the diagnosis of MALA.
Conclusions: Metabolic disease can bring about acute blindness. Metabolic acidosis in a patient with a history of metformin intake should suggest the possibility of MALA, necessitating immediate management, without waiting for results of other examinations, especially in patients with sudden blindness. And further study about reversible blindness-associated severe metabolic acidosis will be needed.
Publisher
Research Square Platform LLC