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British Journal of Anaesthesia 2007 98(2):213-215; doi:10.1093/bja/ael347
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Severe lactic acidosis and rhabdomyolysis following metformin and ramipril overdose

M. Galea1,*, N. Jelacin1, K. Bramham2 and I. White1

1 Department of Anaesthesia and Intensive Care, St Peter's Hospital, Guildford Road, Chertsey KT16 0PZ, UK
2 Department of Medicine, St Helier's Hospital, Wrythe Lane, Carshalton SM5 1AA, UK

* Corresponding author: Department of Anaesthesia and Intensive Care, St Peter's Hospital, Guildford Road, Chertsey KT16 0PZ, UK. E-mail: marylyse{at}doctors.org.uk

We report the case of a 46-yr-old male who developed severe lactic acidosis, cardiorespiratory arrest, and rhabdomyolysis following an overdose of metformin and ramipril. The lactic acidosis was successfully treated with early high-volume continuous veno-venous haemofiltration. Rhabdomyolysis and lower limb compartment syndrome developed later. The patient otherwise made a good recovery. We discuss the management of severe lactic acidosis secondary to metformin overdose and the association with rhabdomyolysis.

Keywords: blood, haemofiltration; complications, acidosis, lactic; complications, rhabdomyolysis; compartment syndrome; metformin


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