PMID- 37586755
OWN - NLM
STAT- MEDLINE
DCOM- 20230818
LR  - 20230819
IS  - 1757-790X (Electronic)
IS  - 1757-790X (Linking)
VI  - 16
IP  - 8
DP  - 2023 Aug 16
TI  - Surviving cardiac arrest from severe metformin-associated lactic acidosis using 
      extracorporeal membrane oxygenation and double continuous venovenous 
      haemodialysis.
LID - 10.1136/bcr-2023-254649 [doi]
LID - e254649
AB  - Metformin-associated lactic acidosis (MALA) is a serious condition with high 
      mortality. This case describes a man in the mid-60s with diabetes mellitus type 2 
      treated with metformin developing MALA 4 days after coronary stenting for 
      non-ST-elevation myocardial infarction. He presented acutely with severe 
      abdominal pain, a lactate of 19 mmol/L and pH 6.74. Despite treatment for MALA, 
      he went into refractory cardiac arrest and was connected to venoarterial 
      extracorporeal membrane oxygenation (VA-ECMO). He suffered a massive haemothorax 
      due to perforation of the right atrial appendage. It was repaired through a 
      sternotomy while being given massive blood transfusions. The following days, he 
      was on VA-ECMO and double continuous venovenous haemodialysis (CVVHD). He 
      survived with only mild paresis of the left hand. VA-ECMO should be considered a 
      rescue therapy alongside treatment with CVVHD in case of cardiac arrest due to 
      severe MALA.
CI  - (c) BMJ Publishing Group Limited 2023. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Akkaoui, Kirstine Krushave
AU  - Akkaoui KK
AD  - Anaesthesia and Intensive Care, Aalborg Universitetshospital, Aalborg, Denmark.
FAU - Andersen, Ljubica Vukelic
AU  - Andersen LV
AD  - Cardiology, Aalborg Universitetshospital, Aalborg, Denmark.
FAU - Norgaard, Martin Agge
AU  - Norgaard MA
AD  - Thoracic Surgery, Aalborg Universitetshospital, Aalborg, Denmark.
FAU - Andreasen, Jo Bonding
AU  - Andreasen JB
AUID- ORCID: 0000-0002-6615-4438
AD  - Thoracic Intensive Care Unit, Aalborg Universitetshospital, Aalborg, Denmark 
      jo.a@rn.dk.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20230816
PL  - England
TA  - BMJ Case Rep
JT  - BMJ case reports
JID - 101526291
RN  - 9100L32L2N (Metformin)
SB  - IM
MH  - Male
MH  - Humans
MH  - *Metformin/adverse effects
MH  - *Extracorporeal Membrane Oxygenation
MH  - *Continuous Renal Replacement Therapy
MH  - *Acidosis, Lactic/chemically induced/therapy
MH  - *Heart Arrest/chemically induced/therapy
PMC - PMC10432636
OTO - NOTNLM
OT  - Adult intensive care
OT  - Cardiovascular medicine
OT  - Dialysis
OT  - Fluid electrolyte and acid-base disturbances
OT  - Resuscitation
COIS- Competing interests: None declared.
EDAT- 2023/08/17 00:42
MHDA- 2023/08/18 06:43
PMCR- 2025/08/16
CRDT- 2023/08/16 20:53
PHST- 2025/08/16 00:00 [pmc-release]
PHST- 2023/08/18 06:43 [medline]
PHST- 2023/08/17 00:42 [pubmed]
PHST- 2023/08/16 20:53 [entrez]
AID - 16/8/e254649 [pii]
AID - bcr-2023-254649 [pii]
AID - 10.1136/bcr-2023-254649 [doi]
PST - epublish
SO  - BMJ Case Rep. 2023 Aug 16;16(8):e254649. doi: 10.1136/bcr-2023-254649.