{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:15:38Z","timestamp":1792800938567,"version":"4.5.0"},"reference-count":14,"publisher":"Walter de Gruyter GmbH","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jpem-2026-0161_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Metformin-associated lactic acidosis (MALA) is a rare but potentially life-threatening condition. Hemodialysis is often recommended, but evidence of successful nondialytic management in children is limited. We report a girl with MALA successfully treated with supportive medical management without dialysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpem-2026-0161_abs_002\">\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      We report a girl with nondialyzed chronic kidney disease (CKD) and non\u2013insulin-dependent diabetes mellitus (NIDDM), and dyslipidemia who developed MALA after 18\u00a0months of metformin, insulin, and sodium bicarbonate therapy. She presented with dyspnea, palpitations, and vomiting. She was lethargic, afebrile, tachypneic, tachycardic, hypertensive, and had Kussmaul breathing. Laboratory results showed blood glucose 55\u202fmg\/dL, potassium 6.7\u202fmEq\/L, arterial pH\u00a07.038, pCO\n                      <jats:sub>2<\/jats:sub>\n                      &lt;5\u202fmmHg, and lactate 19.55 (0.56\u20131.39)\u00a0mmol\/L. She was diagnosed with CKD and NIDDM complicated by acute kidney injury and MALA. She was treated with intravenous glucose, sodium bicarbonate, respiratory support, and rectal calcium polystyrene sulfonate and then referred to our hospital, arriving 9\u202fh after the\u00a0initial presentation. For MALA, hemodialysis (HD) or\u00a0continuous renal replacement therapy (CRRT) was considered, but predialysis COVID-19 testing requirements delayed immediate initiation. Intravenous fluids were maintained at 100\u2013150\u202fcc\/h with urine output of 200\u2013220\u202fcc\/h. Seven hours after arrival, laboratory results improved (pH\u00a07.361, lactate 11.7\u202fmmol\/L), so HD\/CRRT was deferred. Serum bicarbonate and lactate normalized at 25 and 29\u202fh, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpem-2026-0161_abs_003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This report supports that pediatric MALA can be successfully treated without renal replacement therapy, using liberal hydration, alkali therapy, and measures to ensure adequate urine output.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jpem-2026-0161","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:55:45Z","timestamp":1791266145000},"source":"Crossref","is-referenced-by-count":1,"title":["Successful treatment of metformin-associated lactic acidosis without hemodialysis"],"prefix":"10.1515","author":[{"given":"Praewa","family":"Sophark","sequence":"first","affiliation":[{"name":"Department of Pediatrics , Faculty of Medicine, Prince of Songkla University , Hat Yai , Songkhla , Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somchit","family":"Jaruratanasirikul","sequence":"additional","affiliation":[{"name":"Department of Pediatrics , Faculty of Medicine, Prince of Songkla University , Hat Yai , Songkhla , Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pornsak","family":"Dissaneewate","sequence":"additional","affiliation":[{"name":"Department of Pediatrics , Faculty of Medicine, Prince of Songkla University , Hat Yai , Songkhla , Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prayong","family":"Vachvanichsanong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics , Faculty of Medicine, Prince of Songkla University , Hat Yai , Songkhla , Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"2026100605553862184_j_jpem-2026-0161_ref_001","doi-asserted-by":"crossref","unstructured":"Huang, W, Castelino, RL, Peterson, GM. 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J\u00a0Emerg Med 2011;40:271\u20135. https:\/\/doi.org\/10.1016\/j.jemermed.2007.11.055.","DOI":"10.1016\/j.jemermed.2007.11.055"},{"key":"2026100605553862184_j_jpem-2026-0161_ref_004","doi-asserted-by":"crossref","unstructured":"Kajbaf, F, Lalau, JD. The prognostic value of blood pH\u00a0and lactate and metformin concentrations in severe metformin-associated lactic acidosis. BMC Pharmacol Toxicol 2013;14:22. https:\/\/doi.org\/10.1186\/2050-6511-14-22.","DOI":"10.1186\/2050-6511-14-22"},{"key":"2026100605553862184_j_jpem-2026-0161_ref_005","doi-asserted-by":"crossref","unstructured":"Santoli, J, Aldakkour, JL, Tohidi, H, Lin, Y. Metformin-associated lactic acidosis: a case report. HCA Healthc J Med 2023;4:215\u20138. https:\/\/doi.org\/10.36518\/2689-0216.1508.","DOI":"10.36518\/2689-0216.1508"},{"key":"2026100605553862184_j_jpem-2026-0161_ref_006","doi-asserted-by":"crossref","unstructured":"Kim, S, Sarwal, A, Yee, XT, Fraga, SAG, Campion, V, Gnanasekaran, I, et al.. 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J\u00a0Med Case Rep 2019;13:371. https:\/\/doi.org\/10.1186\/s13256-019-2311-5.","DOI":"10.1186\/s13256-019-2311-5"},{"key":"2026100605553862184_j_jpem-2026-0161_ref_009","doi-asserted-by":"crossref","unstructured":"Suzuki, K, Okada, H, Yoshida, S, Okamoto, H, Suzuki, A, Suzuki, K, et al.. Effect of high-flow high-volume-intermittent hemodiafiltration on metformin-associated lactic acidosis with circulatory failure: a case report. J\u00a0Med Case Rep 2018;12:280. https:\/\/doi.org\/10.1186\/s13256-018-1809-6.","DOI":"10.1186\/s13256-018-1809-6"},{"key":"2026100605553862184_j_jpem-2026-0161_ref_010","doi-asserted-by":"crossref","unstructured":"Stades, AM, Heikens, JT, Erkelens, DW, Holleman, F, Hoekstra, JB. Metformin and lactic acidosis: cause or coincidence? A review of case reports. J\u00a0Intern Med 2004;255:179\u201387. https:\/\/doi.org\/10.1046\/j.1365-2796.2003.01271.x.","DOI":"10.1046\/j.1365-2796.2003.01271.x"},{"key":"2026100605553862184_j_jpem-2026-0161_ref_011","doi-asserted-by":"crossref","unstructured":"Yang, PW, Lin, KH, Lo, SH, Wang, LM, Lin, HD. Successful treatment of severe lactic acidosis caused by a suicide attempt with a metformin overdose. Kaohsiung J Med Sci 2009;25:93\u20137. https:\/\/doi.org\/10.1016\/s1607-551x(09)70047-6.","DOI":"10.1016\/S1607-551X(09)70047-6"},{"key":"2026100605553862184_j_jpem-2026-0161_ref_012","doi-asserted-by":"crossref","unstructured":"Seidowsky, A, Nseir, S, Houdret, N, Fourrier, F. Metformin-associated lactic acidosis: a prognostic and therapeutic study. Crit Care Med 2009;37:2191\u20136. https:\/\/doi.org\/10.1097\/ccm.0b013e3181a02490.","DOI":"10.1097\/CCM.0b013e3181a02490"},{"key":"2026100605553862184_j_jpem-2026-0161_ref_013","doi-asserted-by":"crossref","unstructured":"Terpening, C. MALAdaptive: do we avoid metformin unnecessarily? J\u00a0Am Board Fam Med 2014;27:136\u201341. https:\/\/doi.org\/10.3122\/jabfm.2014.01.120173.","DOI":"10.3122\/jabfm.2014.01.120173"},{"key":"2026100605553862184_j_jpem-2026-0161_ref_014","doi-asserted-by":"crossref","unstructured":"Dichtwald, S, Weinbroum, AA, Sorkine, P, Ekstein, MP, Dahan, E. Metformin-associated lactic acidosis following acute kidney injury. Efficacious treatment with continuous renal replacement therapy. Diabet Med 2012;29:245\u201350. https:\/\/doi.org\/10.1111\/j.1464-5491.2011.03474.x.","DOI":"10.1111\/j.1464-5491.2011.03474.x"}],"container-title":["Journal of Pediatric Endocrinology and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jpem-2026-0161\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jpem-2026-0161\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:55:47Z","timestamp":1791266147000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jpem-2026-0161\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":14,"alternative-id":["10.1515\/jpem-2026-0161"],"URL":"https:\/\/doi.org\/10.1515\/jpem-2026-0161","relation":{},"ISSN":["0334-018X","2191-0251"],"issn-type":[{"value":"0334-018X","type":"print"},{"value":"2191-0251","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]}}}