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April 15, 2026CureusOpen Access

Concurrent Metformin-Associated Lactic Acidosis and Euglycemic Diabetic Ketoacidosis Without Sodium-Glucose Cotransporter 2 Inhibitor Exposure: A Case Report and Literature Review

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Authors

MAMotaz AlmahmoodLALeen AbuafifehASAmin Saied

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Overview

Case report highlights distinct causes of metabolic acidosis with implications for management in diabetes.

Key Points

  • The aim is to explore the rare simultaneous occurrence of metformin-associated lactic acidosis and euglycemic diabetic ketoacidosis.
  • Evaluation of an elderly patient with type 2 diabetes mellitus exhibiting severe metabolic acidosis symptoms.
  • Monitoring of arterial pH, anion gap, lactate levels, ketone bodies, and kidney function.
  • Treatment included intravenous fluids, insulin, sodium bicarbonate, and dialysis.
  • Patient showed profound acidemia and severe metabolic acidosis upon presentation.
  • Treatment led to recovery in hemodynamic, metabolic, and renal functions.
  • Simultaneous presence of high lactate and ketones was identified, impacting patient management.

Cite This Study

Almahmood et al. (2026) studied this question.

synapsesocial.com/papers/69df2a99e4eeef8a2a6af98bhttps://doi.org/10.7759/cureus.106919
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