Article Instance

HTTP 200 OK
Allow: GET
Content-Type: application/json
Vary: Accept

{
    "pk": 50572,
    "title": "Atypical Presentation of Metformin-Associated Lactic Acidosis: A Case Report",
    "subtitle": null,
    "abstract": "<p><strong>Introduction: </strong>Metformin, a first-line type two diabetes medication, is generally considered safe and effective. However, it is rarely associated with life-threatening lactic acidosis. This generally presents in patients with gastrointestinal upset as a primary complaint. It is most common in patients with underlying chronic kidney disease. Prevention of associated mortality requires early diagnosis and intervention with fluids, bicarbonate, vasopressors, and hemodialysis.</p>\n<p><strong>Case Report: </strong>This is a notable presentation of metformin toxicity, as the 68-year-old male patient presented with an atypical chief complaint of dyspnea and no history of kidney disease. Physical exam was notable for tachypnea and clear breath sounds. Labs revealed anion gap metabolic acidosis from an accumulation of lactic acid and acute renal failure. Other causes of lactic acid metabolic acidosis were considered and ruled out. Nephrology was consulted and pharmacological therapies started as the patient transitioned to the intensive care unit for emergent hemodialysis. He eventually regained renal function and was discharged. His metformin level returned several weeks later significantly elevated.</p>\n<p><strong>Conclusion</strong>: Emergency physicians should maintain metformin toxicity on the differential for patients on metformin presenting with dyspnea and anion gap metabolic acidosis with elevated serum lactic acid concentrations. Other sources of lactic acidosis should be ruled out, and corrective therapies, including renal replacement therapies, should be started immediately. Additionally, it is essential to determine a patient’s kidney function before being prescribed metformin and to have the patient serially monitored as an outpatient.</p>",
    "language": "eng",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Metformin"
        },
        {
            "word": "lactic acidosis"
        },
        {
            "word": "case report"
        }
    ],
    "section": "Case Reports",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/3wk9474r",
    "frozenauthors": [
        {
            "first_name": "Elizabeth",
            "middle_name": "",
            "last_name": "Welsch",
            "name_suffix": "",
            "institution": "Medical College of Wisconsin, Milwaukee, Wisconsin",
            "department": ""
        },
        {
            "first_name": "Jerome",
            "middle_name": "",
            "last_name": "Evans",
            "name_suffix": "",
            "institution": "University of Wisconsin, Madison, Wisconsin",
            "department": ""
        },
        {
            "first_name": "Alexander",
            "middle_name": "",
            "last_name": "Yoxall",
            "name_suffix": "",
            "institution": "Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin",
            "department": ""
        },
        {
            "first_name": "Anna",
            "middle_name": "",
            "last_name": "Culhane",
            "name_suffix": "",
            "institution": "Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin",
            "department": ""
        }
    ],
    "date_submitted": "2025-08-11T13:47:52.438000-07:00",
    "date_accepted": "2025-12-30T03:58:21.858000-08:00",
    "date_published": "2026-04-07T16:00:00-07:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "PDF",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/50572/galley/49505/download/"
        }
    ]
}