Severe Complication of Diabetic Ketoacidosis and Metformin Intoxication: Bilateral Leg Amputation

Introduction

Metformin is a biguanide oral hypoglycemic agent. It is used for the treatment of type 2 diabetes mellitus (T2DM ) Lactic acidosis and rhabdomyolysis is a known but rare adverse effect of metformin (Arali A et al., Bahrain Med Bull 2015; 37: 256–259).

High-dose metformin, may cause severe metabolic acidosis with hyperlactatemia and frequently has fatal outcomes (Arali A et al., Bahrain Med Bull 2015; 37: 256–259, Chu CK et al. J Chin Med Assoc 2003; 66 (8): 505–508).

Macrovascular and microvascular complications are essential causes of morbidity and mortality in patients with T1DM and T2DM. Exposure to high glucose values causes injury to endothelial cells resulting in these complications (Chen J et al., Clin Chim Acta 2020; 507: 242–247).

In this report, we present a 17-year-old male who had been monitored for T1DM for 14 years. The patient was admitted to the intensive care unit (ICU) due to diabetic ketoacidosis (DKA), metformin intoxication, and multiple organ failure. The patient was in a ketoacidosis coma with lactic acidosis and rhabdomyolysis findings, thus we began veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and continuous venovenous hemodiafiltration (CVHDF) treatment. However, with fulminant progression despite these treatments, a thrombocytopenia-associated multiple organ failure (TAMOF) tableau developed and both lower extremities were amputated below the knee.

This case is presented to show the serious complications that may occur with exposure to severe acidosis in uncontrolled diabetes.

Publication History

Article published online:
28 July 2021