Successful treatment of metformin-associated lactic acidosis without hemodialysis

Abstract Objectives Metformin-associated lactic acidosis (MALA) is a rare but potentially life-threatening condition. Hemodialysis is often recommended, but evidence of successful nondialytic management in children is limited. We report a girl with MALA successfully treated with supportive medical management without dialysis. Case presentation We report a girl with nondialyzed chronic kidney disease (CKD) and non–insulin-dependent diabetes mellitus (NIDDM), and dyslipidemia who developed MALA after 18 months of metformin, insulin, and sodium bicarbonate therapy. She presented with dyspnea, palpitations, and vomiting. She was lethargic, afebrile, tachypneic, tachycardic, hypertensive, and had Kussmaul breathing. Laboratory results showed blood glucose 55 mg/dL, potassium 6.7 mEq/L, arterial pH 7.038, pCO 2 Conclusions This report supports that pediatric MALA can be successfully treated without renal replacement therapy, using liberal hydration, alkali therapy, and measures to ensure adequate urine output.