Key result
Correcting profound metformin-associated lactic acidosis resolves pseudo-ischemic ECG changes by hospital day 3.
Why the study?
Metformin-induced lactic acidosis can cause ECG changes and precipitate cardiac arrest, but recognition of this metabolic cause is crucial for management.
Case Report (n=1)
No
Profound metabolic acidosis associated with metformin use and sepsis can trigger ventricular fibrillation and pseudo-ischemic ECG changes that completely resolve upon correction of the underlying metabolic derangement without requiring emergent coronary intervention.
Answers are grounded in this paper and cite their sources.
Consider metformin-associated lactic acidosis in unexplained VF arrest with pseudo-STEMI ECGs; this case leaves open broader validation.
BACKGROUND: Metformin-induced lactic acidosis can cause electrocardiographic (ECG) changes and precipitate cardiac arrest. CASE SUMMARY: A 58-year-old woman presented to the emergency department after a ventricular fibrillation arrest. Laboratory findings on admission showed severe lactic acidosis, and ECG showed ischemic changes concerning for a ST-segment elevation myocardial infarction. After treatment of the patient's sepsis, urinary tract infection, and acute kidney injury, she improved, and the pseudo-ischemic ECG changes resolved. DISCUSSION: Metformin is a known instigator of lactic acidosis, particularly in patients with renal failure. On rare occasion, such lactic acidosis secondary to metformin can produce lethal arrhythmias. This case demonstrates the need for providers to consider metabolic derangements in patients with ventricular fibrillation arrest and subsequent ECG changes. TAKE-HOME MESSAGE: It is crucial for providers to recognize metabolic acidosis as a precipitator of cardiac arrest and to identify patients who take metformin who are at risk for metformin-associated lactic acidosis.
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Grant et al. (2026) conducted a case report in Metformin-associated lactic acidosis with ventricular fibrillation arrest and pseudo-ischemic ECG changes (n=1). Metformin-associated lactic acidosis (treated with intravenous 8.4% sodium bicarbonate, fluids, and antibiotics) was evaluated on Resolution of metabolic acidosis and pseudo-ischemic ECG changes. Correction of profound metformin-associated lactic acidosis (pH 6.84, lactate 18.5 mmol/L) normalized pH and resolved pseudo-ischemic ECG changes by hospital day 3.
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