Metformin-induced lactic acidosis and acute pancreatitis precipitated by diuretic, celecoxib, and candesartan-associated acute kidney dysfunction

Polypharmacy may lead to synergistic complications from the different medications. We report the case of a 50-year-old woman who was prescribed 11 drugs, including a diuretic, celecoxib, metformin, and candesartan, and who developed acute kidney dysfunction while on these drugs, manifesting as severe proteinuria, acute azotemia, hyperkalemia. The kidney injury caused the accumulation of metformin, leading to lactic acidosis and acute pancreatitis. Sodium bicarbonate hemodialysis not only improved the metabolic abnormalities but also hastened the removal of metformin.

[1]  D. Feinfeld,et al.  Nephrotic Syndrome Associated with Use of the Nonsteroidal Anti-Inflammatory Drugs , 1984 .

[2]  Underwood Tw,et al.  Drug-induced pancreatitis. , 1993 .

[3]  Acute Pancreatitis Associated with Celecoxib , 2000, Annals of Internal Medicine.

[4]  R. Carrillo-Jimenez,et al.  Celecoxib-induced acute pancreatitis and hepatitis: a case report. , 2000, Archives of internal medicine.

[5]  N. K. Krane,et al.  Nephrotic syndrome and interstitial nephritis associated with celecoxib. , 2002, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[6]  H. Thabet,et al.  Metformin associated acute pancreatitis. , 2002, Veterinary and human toxicology.

[7]  C. Nzerue,et al.  Celecoxib-induced acute interstitial nephritis. , 2002, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[8]  Acute pancreatitis: a rare complication of celecoxib , 2002, Internal medicine journal.

[9]  G. Price.  Metformin lactic acidosis, acute renal failure and rofecoxib. , 2003, British journal of anaesthesia.

[10]  Morten Andersen,et al.  Exposure to potential drug interactions in primary health care , 2003, Scandinavian journal of primary health care.

[11]  S. Mallick.  Metformin induced acute pancreatitis precipitated by renal failure , 2004, Postgraduate Medical Journal.

[12]  A. Fournier,et al.  Bicarbonate haemodialysis: an adequate treatment for lactic acidosis in diabetics treated by metformin , 2004, Intensive Care Medicine.

[13]  M. Kanbay,et al.  Acute Pancreatitis Associated with Combined Lisinopril and Atorvastatin Therapy , 2005, Digestive Diseases.

[14]  D. Karamanolis,et al.  A case of acute pancreatitis possibly associated with combined salicylate and simvastatin treatment. , 2005, JOP : Journal of the pancreas.

[15]  C. De Simone,et al.  Acute pancreatitis associated with irbesartan therapy. , 2005, Pancreas.

[16]  B. Humphreys,et al.  Acetaminophen-induced anion gap metabolic acidosis and 5-oxoprolinuria (pyroglutamic aciduria) acquired in hospital. , 2005, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[17]  D. Feinfeld,et al.  Acute Renal Dysfunction in Acetaminophen Poisoning , 2005, Renal failure.

[18]  H. Sørensen,et al.  Newer cyclo‐oxygenase‐2 selective inhibitors, other non‐steroidal anti‐inflammatory drugs and the risk of acute pancreatitis , 2006, Alimentary pharmacology & therapeutics.

[19]  H. Gudmundsdottir,et al.  Metformin and antihypertensive therapy with drugs blocking the renin angiotensin system, a cause of concern? , 2006, Clinical nephrology.

[20]  Jeremy L. Johnson,et al.  A Case of Simvastatin‐Associated Pancreatitis and Review of Statin‐Associated Pancreatitis , 2006, Pharmacotherapy.