Rashid U, Marra EM, Tran VH. Bilateral Ureteral Obstruction Causing Acute Kidney Injury and Resultant Metformin Toxicity.
Cureus 2021;
13:e19635. [PMID:
34956761 PMCID:
PMC8675570 DOI:
10.7759/cureus.19635]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/20/2022] Open
Abstract
A 55-year-old male with a past medical history of type 2 diabetes mellitus on metformin presented to the emergency department (ED) due to shortness of breath and three days of lumbar back pain. Workup revealed bilateral obstructing ureteral stones causing bilateral hydronephrosis, acute kidney injury (AKI), and profound anion gap metabolic acidosis due to concomitant metformin-associated lactic acidosis (MALA). In the ED, the patient developed profound shock refractory to fluid resuscitation, requiring initiation of multiple vasopressors, and stress dose steroids. He was transferred to the interventional radiology suite for bilateral percutaneous nephrostomy tubes and only improved once continuous renal replacement therapy was initiated.
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