Case Report

Metformin-Associated Lactic Acidosis in a Diabetic Patient with Normal Kidney Function and Occult Cirrhosis

Table 1

Laboratory results.

TestT0 on admissionT9 presurgeryT15 postsurgery

Hemoglobin, g/dL6.48.47.1
Hematocrit21%26%22%
MCV1009493
White blood cells36,86024,70016,040
Platelets250,000155,000117,000
Urea, mg/dL (mmol/L)130 (7.15)113 (6.21)106 (5.83)
Creatinine, mg/dL (μmol/L)0.96 (84.88)0.99 (87.54)1.07 (94.61)
Sodium, mmol/L127143148
Potassium, mmol/L4.43.63.7
Bicarbonate4756
Chloride909796
pH (ABG)6.717.016.98
pCO2, mmHg242323
Plasma osmolarity300
Prothrombin time46%40%
INR1.551.73
CRP, mg/dL (mg/L)2.1 (21)1.7 (17)
L-Lactate (normal: 4.5-19.8 mg/dl)284 mg/dL or 31.5 mmol/L
Reticulocytes’ count50000
LDH, U/L430
Haptoglobin0.43
Protein, g/L49
Albumin, g/L20
Calcium, mg/dL (mmol/L)8.8 (0.484)9.8 (0.539)8.7 (0.478)
Phosphorus, mg/dL (mmol/L)9.2 (0.506)9.1 (0.5)8.7 (0.478)
Magnesium, mg/dL (mmol/L)2.4 (0.132)2.3 (0.126)2.3 (0.126)
ASAT, U/L103
GGT, U/L95
Total bilirubin, mg/dL (mmol/L)1.0 (0.055)
Direct bilirubin, mg/dL (mmol/L)0.4 (0.022)
Lipase, U/L81
Fibrinogen, mg/dL (μmol/L)232 (2.72)
D-Dimer, μg/mL0.1

Note: ABG: arterial blood gas; CRP: C-reactive protein; AST: aspartate aminotransferase; GGT: gamma-glutamyl transferase. T reflects time in hours since the admission to the emergency room; SI represents units in parenthesis.