Euglycemic Ketoacidosis and Lactic Acidosis Associated With Metformin Toxicity

Division

North Florida

Hospital

Osceola Regional Medical Center

Document Type

Case Report

Publication Date

5-20-2024

Keywords

diabetes, diabetes type 2, euglycemia, hypoglycemia, mellitus, metformin

Disciplines

Endocrine System Diseases | Internal Medicine | Medicine and Health Sciences | Nutritional and Metabolic Diseases

Abstract

In patients with diabetes, diabetic ketoacidosis (DKA) is a well-documented potential complication, usually presenting with hyperglycemia, anion gap acidosis, and positive ketones. Metformin toxicity in the setting of acute renal failure is also a well-known cause of lactic acidosis. However, metformin-induced euglycemic ketoacidosis is less well-known or studied. We report a case of metformin toxicity in the setting of acute renal failure with both lactic acidosis and ketosis and an initial confounded clinical presentation of sulphonylurea-induced hypoglycemia. A high index of suspicion for metformin-associated lactic acidosis (MALA) and metformin-associated lactic acidosis with euglycemic ketoacidosis (MALKA) should be in place in patients who are taking metformin and presenting with acute renal failure and euglycemia.

Publisher or Conference

Cureus

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