Early and prolonged continuous hemodiafiltration for the treatment of severe Metformin-Associated Lactic Acidosis

In this article, we discuss the case of a 42-year-old female diabetic patient who developed severe lactic acidosis, coma, shock, rhabdomyolysis, and renal and hepatic failure during metformin therapy after alcohol abuse. The APACHE II score of this patient was 38, which is associated with an estimated mortality rate >88%. Conventional treatment of acidosis with IV infusion of sodium bicarbonate (400 mmol) was ineffective in restoring a normal acid/base balance. Lactic acidosis was successfully treated with bicarbonate-buffered continuous veno-venous hemodiafi ltration. The patient also had a complete recovery from all complications.