DOI: 10.36347/sjmcr.2017.v05i07.011

Pages: 446-447

Metformin, commonly used in patients with type 2 diabetes mellitus (DM), is a reliable oral antidiabetic agent in the group of biguanides. These agents are effective by increasing cellular insulin sensitivity. They do not cause hypoglycaemia, even at very high doses, because they exhibit their effects with an antihyperglycemic effect from the pathway of hypoglycaemia. An eighty-year-old male patient was admitted to the emergency department with complaints of general malaise, nausea, vomiting, abdominal pain, shortness of breath. Story is that hypertension, type 2 dıabetes mellitus, heart failure and chronic obstructive pulmonary disease (COPD) are diagnosed; Metformin, ramipril + hydrochlorothiazide, diltiazem and inhaler treatments. Laboratory findings: BUN: 26 mg / dL, Cr: 1,2 mg / dL, K: 4.83 mmol / L, Pco2:46, arterial blood gas pH: 7.27, HCO3: 13,3 mmHg, lactate level: 6.1 mg / dl. Urinalysis is glucose and ketone negatif. The patient was diagnosed with heart failure and metformin-related lactic acidosis. Metformin was cut immediately and emergency hemodialysis was planned. Parenteral 0.9% NaCl, neutralized glucose - insulin solution, NaHCO3 infusion therapy was started. A dramatic improvement was noted in the patient's follow-up and there was no need for dialysis. In the literature, hemodialysis is the first treatment approach in cases, but we have achieved a very positive outcome without needing hemodialysis.