Neutropenia associated with the use of low-dose methotrexate in a peritoneal dialysis patient

5 l/h) for 16 h (Figure 1), lactic acidosis improved, the haemodynamic situation of the patient stabilized and he was discharged from the ICU. In conclusion, metformin intoxication should be considered in the differential diagnosis for patients with lactic acidosis in the absence of obvious tissue hypoxia [5]. Only early treatment, even in a suspicious case of metformin intoxication, is able to reduce the high mortality rates in these patients. This case report demonstrates the usefulness of the combination of intermittent haemodialysis with high-volume CVVH using two vascular access sites in the treatment of a patient with severe metformin-induced lactic acidosis and extremely high serum metformin concentrations.