Metformin-Associated Lactic Acidosis in a Pregnant Patient

Abstract

Metformin-associated lactic acidosis is a rare but serious condition and potentially even more hazardous during pregnancy. We reported a case of lactic acidosis in a 28-year-old pregnant woman (gravida 3, para 0, abortion 2, ante-partum 22 weeks) after ingestion of 39.50 g (approximately 80 tablets) metformin in a suicide attempt. She had no pre-existing systemic illness. Analysis of arterial blood gases revealed a high anion gap (28.1 mEq/l) and a normal osmol gap (8 mEq/l) metabolic acidosis. Other etiologies of high anion gap and normal osmol gap metabolic acidosis were excluded by laboratory investigation. The patient was treated on an emergency basis and received aggressive fluid management, intravenous sodium bicarbonate (1 mEq/kg) and activated charcoal, orally. The fetal condition was monitored intensively. The fetus was delivered smoothly via vaginal delivery in a healthy state at the 38th gestational week. Clinical follow-up over the next 2 years confirmed no congenital abnormality. We present a case of successful management of metformin-associated lactic acidosis during pregnancy, treated simply, with intravenous sodium bicarbonate and intensive fetal monitoring. This relatively noninvasive method is an effective treatment option. However, hemodialysis still has a valuable role in the management of acidosis which proves refractory to conservative treatment, such as that described.

Metformin: A Drug of Choice for Gestational Diabetes Mellitus in Near Future- Hope or Despair?

“…Metformin is a category B drug, indicating that there is no evidence of fetal or animal teratogenicity 29 . Metformin smoothly crosses the placenta and henceforth there is concern regarding possible adverse effects on the fetus [30][31] . Despite valid concerns, there have been clinical reports of Metformin use in diabetic pregnancy since 1966.…”

Comparação entre a metformina e a insulina no tratamento do diabetes gestacional: ensaio clínico randomizado

“…Outro ponto bastante debatido em relação ao uso da metformina é a segurança para o feto. Salienta-se que, nos estudos analisados, não foram 56 descritos casos de teratogenicidade (26,(28)(29)(30)(31)(40)(41)(42)(43)(44)(45)(47)(48)(49)(50)(51)61) , mesmo naqueles em que a medicação foi utilizada no período embrionário, não foram encontrados efeitos deletérios para o feto (26,28,34,35) . Ainda, em relação à segurança da metformina, Glueck et al (62) (40) , Rowan et al (41) , Terti et al (42) e Silva et al (50) .…”