Early initiation of continuous renal replacement therapy for metformin-associated lactic acidosis

Introduction. Rapid diagnosis of metformin-associated lactic acidosis (MALA) and initiation continuous renal replacement therapy (CRRT) in diabetic patient successfully corrects a severe metabolic disorder with acute failure. Case outline. A 58-year-old male medical history type 2 diabetes alcohol abuse was admitted to the Emergency Department because vomiting, diarrhea, altered mental status. Initial arterial blood gas analysis revealed (pH: 6.8, PaCO2: 12 mmHg, HCO3: 3.2 mmol/l), but lactate level too high measure. MALA suspected based on progressive past intake metformin. Renal initiated ? veno?venous hemodiafiltration, as result significant improvement clinical status, both pH showing normalization, achieved after finishing CRRT. Conclusion. carries an ominous prognosis. This case suggests early CRRT hemodynamically unstable patients MALA.