2014 Volume 5 Issue 2 Pages 149-152
A 80-year-old woman was transferred to our medical intensive care unit because of vomiting and unconsciousness. She had taken type 2 diabetes medication for 25 years and had been under hemodialysis therapy for 6 years. Her systolic blood pressure was 91 mmHg. Blood gas analysis revealed severe lactic acidosis: pH 6.724, lactate 30 mmol/L. Sustained low-efficiency dialysis (SLED) with a blood flow rate of 120mL/min and a dialysate flow rate of 300mL/min was initiated to treat the metabolic acidosis. After initiating the SLED, we were informed that she had taken biguanide (buformin) for 5 days. To remove the buformin, high-flow hemodialysis with an increased dialysate flow rate (700mL/min) was performed for 12 hours. She underwent intermittent hemodialysis treatment on the second and the third day. After the treatment, her vital signs were stable and metabolic acidosis improved. Her blood buformin level was 3,790 ng/mL on arrival and 940 ng/mL after hemodialysis on the second day (Cmax 260〜410ng/mL). Biguanide-associated lactic acidosis is a rare but potentially life-threatening complication. In our case, a good prognosis was obtained by prompt diagnosis and early treatment with high-flow hemodialysis.
