Hiperlactacidemia por metformina: Presentación de un caso clínico sin acidosis metabólica aparente y revisión de la literatura

This is a case report of a patient with diabetes type 2 treated with metformin who was admitted to the intensive care unit because of an ischemic stroke. Blood tests showed a hyperlactatemia of 4.8 mmol/l, with normal pH, bicarbonate, and base excess. However, Stewart approach allowed the detection of a mixed metabolic disorder: metabolic acidosis due to unmeasured anions plus hypochloremic alkalosis. Anion gap was elevated and its values decreased in parallel to lactate levels. We review metformin-induced lactic acidosis and the diagnostic approach to this metabolic acid-base disturbance. Metformin-induced hyperlactatemia: A case report and review of the literature