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449980 
Journal Article 
Metformin-induced lactic acidosis and acute pancreatitis precipitated by diuretic, celecoxib, and candesartan-associated acute kidney dysfunction 
Audia, P; Feinfeld, DA; Dubrow, A; Winchester, JF 
2008 
1 
Clinical Toxicology
ISSN: 1556-3650
EISSN: 1556-9519 
46 
2 
164-166 
English 
Polypharmacy may lead to synergistic complications from the different medications. We report the case of a 50-year-old woman who was prescribed II 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. 
metformin; celecoxib; candesartan; lactic acidosis; acute kidney; injury; pancreatitis; interstitial nephritis; nephrotic syndrome; renal-failure; therapy; drugs