{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,9,16]],"date-time":"2024-09-16T16:45:26Z","timestamp":1726505126426},"reference-count":15,"publisher":"California Digital Library (CDL)","issue":"5","license":[{"start":{"date-parts":[[2021,5,6]],"date-time":"2021-05-06T00:00:00Z","timestamp":1620259200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction: Metformin is a biguanide used to treat diabetes mellitus (DM). Metformin-associated lactic acidosis (MALA) carries a high mortality and can occur in patients with renal failure from drug bioaccumulation. Reversible vision loss is a highly unusual, rarely reported complication of MALA. We present a case of a patient whose serum metformin concentration was unusually high and associated with vision loss. \n\nCase Report: A 60-year-old woman presented to an outside hospital emergency department with acute vision loss after being found at home confused, somnolent, and hypoglycemic, having last being seen normal two days prior. She reported vomiting and diarrhea during that time and a recently treated urinary tract infection. The visual loss resolved with continuous renal replacement therapy.\n\nConclusion: This novel case of a patient with Type II DM prescribed metformin and insulin who developed reversible vision loss while suffering from MALA highlights the potential for vision loss in association with MALA.<\/jats:p>","DOI":"10.5811\/cpcem.2021.3.51141","type":"journal-article","created":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T05:28:02Z","timestamp":1621574882000},"page":"206-209","source":"Crossref","is-referenced-by-count":1,"title":["Reversible Total Vision Loss Caused by Severe Metformin-associated Lactic Acidosis: A Case Report"],"prefix":"10.5811","volume":"2","author":[{"given":"Andrew","family":"Koons","sequence":"first","affiliation":[{"name":"Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Amaducci","sequence":"additional","affiliation":[{"name":"Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Katz","sequence":"additional","affiliation":[{"name":"Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"29705","published-online":{"date-parts":[[2021,5,6]]},"reference":[{"doi-asserted-by":"publisher","unstructured":"Richy FF, Sabid\u00f3-Espin M, Guedes S, et al. Incidence of lactic acidosis in patients with type 2 diabetes with and without renal impairment treated with metformin: a retrospective cohort study. Diabetes Care. 2014;37(8):2291-5.","key":"ref0","DOI":"10.2337\/dc14-0464"},{"doi-asserted-by":"publisher","unstructured":"Li L, Jick S, Gopalakrishnan C, et al. Metformin use and risk of lactic acidosis in people with diabetes with and without renal impairment: a cohort study in Denmark and the UK. Diabet Med. 2017;34(4):485-9.","key":"ref1","DOI":"10.1111\/dme.13203"},{"doi-asserted-by":"publisher","unstructured":"Kajbaf F and Lalau JD. The prognostic value of blood pH and lactate and metformin concentrations in severe metformin-associated lactic acidosis.\u00a0BMC Pharmacol Toxicol. 2013;14:22.","key":"ref2","DOI":"10.1186\/2050-6511-14-22"},{"doi-asserted-by":"publisher","unstructured":"Calello DP, Liu KD, Wiegand TJ, et al. Extracorporeal treatment for metformin poisoning: systematic review and recommendations from the Extracorporeal Treatments in Poisoning Workgroup. Crit Care Med. 2015;43(8):1716-30.","key":"ref3","DOI":"10.1097\/ccm.0000000000001002"},{"doi-asserted-by":"publisher","unstructured":"Kreshak AA and Clark RF. Transient vision loss in a patient with metformin-associated lactic acidosis. Am J Emerg Med. 2010;28(9):1059.e5-7.","key":"ref4","DOI":"10.1016\/j.ajem.2010.01.024"},{"doi-asserted-by":"publisher","unstructured":"Cigarr\u00e1n S, Rodriguez ML, Pousa M, et al. Transient vision loss in a patient with severe metformin-associated lactic acidosis. QJM. 2012;105(8):781-3.","key":"ref5","DOI":"10.1093\/qjmed\/hcr109"},{"unstructured":"Hashmi M, Mahmood SN, Madhwani V, et al. Turning a blind eye: acute vision loss from an unexpected cause. Am J Respir Crit Care Med. 2018;197:A6876.","key":"ref6"},{"doi-asserted-by":"publisher","unstructured":"Jeon JW, Choi W, Kim HR, et al. Transient blindness in a patient with severe metformin-associated lactic acidosis (MALA).\u00a0Electrolyte Blood Press. 2019;17(1):16-20.","key":"ref7","DOI":"10.5049\/ebp.2019.17.1.16"},{"doi-asserted-by":"crossref","unstructured":"Ryu S, Oh SK, Son SH, et al. Reversible acute blindness in suspected metformin-associated lactic acidosis. J Emerg Med. 2019;57(5):e153-6.","key":"ref8","DOI":"10.1016\/j.jemermed.2019.06.047"},{"doi-asserted-by":"publisher","unstructured":"Peters N, Jay N, Barraud D, et al. Metformin-associated lactic acidosis in an intensive care unit.\u00a0Crit Care. 2008;12(6):R149.","key":"ref9","DOI":"10.1186\/cc7137"},{"doi-asserted-by":"publisher","unstructured":"Andrzejewski S, Gravel SP, Pollak M, et al. Metformin directly acts on mitochondria to alter cellular bioenergetics. Cancer Metab. 2014;2:12.","key":"ref10","DOI":"10.1186\/2049-3002-2-12"},{"doi-asserted-by":"publisher","unstructured":"Madiraju AK, Erion DM, Rahimi Y, et al. Metformin suppresses gluconeogenesis by inhibiting mitochondrial glycerophosphate dehydrogenase. Nature. 2014;510(7506):542-6.","key":"ref11","DOI":"10.1038\/nature13270"},{"doi-asserted-by":"publisher","unstructured":"Yeh HC, Ting IW, Tsai CW, et al. Serum lactate level and mortality in metformin-associated lactic acidosis requiring renal replacement therapy: a systematic review of case reports and case series. BMC Nephrol. 2017;18(1):229.","key":"ref12","DOI":"10.1186\/s12882-017-0640-4"},{"doi-asserted-by":"publisher","unstructured":"Abu Hossain S, Chaudhry FA, Zahedi K, et al. Cellular and molecular basis of increased ammoniagenesis in potassium deprivation. Am J Physiol Renal Physiol. 2011;301(5):F969-78.","key":"ref13","DOI":"10.1152\/ajprenal.00010.2011"},{"doi-asserted-by":"crossref","unstructured":"Jacobs RA, Meinild AK, Nordsborg NB, et al. Lactate oxidation in human skeletal muscle mitochondria. Am J Physiol Endocrinol Metab. 2013;304(7):E686-94.","key":"ref14","DOI":"10.1152\/ajpendo.00476.2012"}],"container-title":["Clinical Practice and Cases in Emergency Medicine"],"original-title":[],"deposited":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T05:28:11Z","timestamp":1621574891000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/5qr3n778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,6]]},"references-count":15,"issue-title":["Clinical Practice and Cases in Emergency Medicine"],"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,18]]}},"URL":"https:\/\/doi.org\/10.5811\/cpcem.2021.3.51141","relation":{},"ISSN":["2474-252X","2474-252X"],"issn-type":[{"type":"electronic","value":"2474-252X"},{"type":"print","value":"2474-252X"}],"subject":[],"published":{"date-parts":[[2021,5,6]]}}}