Lactic Acidosis

Metformin-associated Lactic Acidosis Masquerading as Ischemic Bowel

A 69-year-old male inpatient on the psychiatric ward developed abdominal pain, nausea, non-bloody emesis, and diaphoresis shortly after eating. His medical history included depression, coronary artery disease, diabetes mellitus, and dyslipidemia. His medications included clopidogrel, gabapentin, glipizide, lisinopril, metformin, metoprolol, omeprazole, rosuvastatin, and sertraline. He denied overdosing on any medications. His vital signs were a heart rate of 74 beats/min, temperature of 36.2°C, respiratory rate of 24 breaths/min, and blood pressure of 82/52 mm Hg.

The examination revealed decreased bowel sounds, voluntary guarding, and tenderness to palpation in the lower abdomen, which appeared out of proportion to the physical examination. A rectal examination revealed impacted stool and a positive stool guaiac... The patient was admitted to the intensive care unit for presumed sepsis and possible ischemic bowel.

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 -- Chase S. Correia, BA, Kirk A. Bronander, MD

This article originally appeared in May 2012 issue of The American Journal of Medicine.