Metformin is a biguanide oral hypoglycemic agent commonly used in the treatment of diabetes mellitus. Metfofmin is excreated largely by the kidney and binds only negligibly to plasma proteins. Toxicity is usually seen when metformin is prescribed to patients with renal insufficiency. Lactic acidosis in diabetics on metformin therapy is rare but still associated with poor prognosis. For an early diagnosis, clinical symptoms of intoxication should be well known by physicians and patients. First-line therapy for correction of lactic acidosis and effective elimination of metformin is bicarbonate hemodialysis. We report a case of acute renal failure due to metformin-associated lactic acidosis in elderly type 2 diabetes mellitus patient and she was successfully treated by hemodialysis with bicarbonate buffer.
Acidosis, Lactic* ; Acute Kidney Injury* ; Aged* ; Blood Proteins ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Early Diagnosis ; Humans ; Kidney ; Metformin ; Prognosis ; Renal Dialysis ; Renal Insufficiency

This study was designed to identify the causes of the development of carpal tunnel syndrome (CTS) associated with end stage kidney disease (ESKD). A total of 112 patients with ESKD, 64 on hemodialysis (HD) and 48 on peritoneal dialysis (PD), were enrolled. The duration of ESKD and dialysis, the site of the arteriovenous (A-V) fistula for HD, laboratory data such as blood urea nitrogen, creatinine, and beta-2-microglobulin were determined. Clinical evaluation of CTS and electrophysiological studies for the diagnosis of CTS and peripheral neuropathy were performed. The electrophysiological studies showed that the frequency of CTS was not different in the HD and PD groups (P = 0.823) and the frequency of CTS was not different in the limb with the A-V fistula compared to the contralateral limb (P = 0.816). The frequency of HD and PD were not related to beta-2-microglobulin levels, an indicator of amyloidosis. The frequency of CTS did not increase as the severity of the peripheral neuropathy and the duration of ESKD and dialysis increased (P = 0.307). The results of this study do not support that microglobulin induced amyloidosis or placement of an A-V fistula are associated with an increase in CTS.
Adult ; Aged ; Amyloidosis/complications ; Arteriovenous Fistula/complications ; Blood Urea Nitrogen ; Carpal Tunnel Syndrome/*complications/*diagnosis ; Creatinine/blood ; Electrophysiological Phenomena ; Female ; Humans ; Kidney Failure, Chronic/*complications/*therapy ; Male ; Middle Aged ; Peritoneal Dialysis/adverse effects ; Polyneuropathies/*complications/*diagnosis ; Renal Dialysis/adverse effects ; beta 2-Microglobulin/blood