A-54-year-old patient with a history of anxiety, type 2 diabetes, and stroke attempted suicide by ingestion of 80 grams metformin. Gastric content aspiration followed by the activated charcoal administration was performed at the ED. The patient suffered from vomiting and diarrhea; the following arterial blood gas findings were noted: pH: 7.33 PaCO 2: 4.8 kPa and PaO 2 -12.8 kPa Bicarbonate: 19.3 mmol/L and base deficits 7 mmol/L Blood glucose:17.9 mmol/L Metabolic acidosis was found deteriorated after three hours of metformin ingestion, with serum lactate level of 8.5 mmol/L and pH 7.23.
At 150 mL/min blood flow, urgent hemodialysis (HD) was performed with a surface area of 1.4 m 2 . The patient becomes acidotic and circulatory unstable during HD, and was transferred to the ICU for circulatory support and for continuous venovenous hemofiltration (CVVH). The patient becomes stable,…
