CASE REPORT   

Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2021 December;180(12):870-3

DOI: 10.23736/S0393-3660.20.04320-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Metformin-associated lactic acidosis: underlying multiple myeloma

Clara GOMES ¹ ✉, Ana FERREIRA ¹, Neuza SOARES ¹, Vanessa CHAVES ¹, Luís LEMOS ¹, Sofia TAVARES ¹, Marta COUTO ²

¹ Department of Internal Medicine, University Hospital of São João, Porto, Portugal; ² Department of Intensive Care, University Hospital of São João, Porto, Portugal

We present the case of a 75-year-old diabetic female with no history of chronic kidney disease, treated with metformin, that complained of vomiting and abdominal pain in the last month; at admission she had acute kidney injury and severe lactic acidosis. She evolved quickly to vasoplegic shock, and immediately started treatment with vasopressors and continuous renal replacement therapy (RRT). Lactic acidosis solved and hemodynamic status recovered, but renal dysfunction persisted. After etiologic study she was diagnosed with multiple myeloma. Metformin-associated lactic acidosis (MALA) is a cause of multiple organ dysfunction, including renal dysfunction; however, patients are typically weaned from RRT within 72 hours. One should be aware of the transient nature of this condition in order to carefully investigate unrecovered renal function among patients with MALA. Diagnosis of multiple myeloma should not be delayed, and treatment should be started immediately in order to improve odds of renal recovery and the prognosis of this condition.

KEY WORDS: Acidosis, lactic; Multiple myeloma; Case reports