Journal
CLINICAL TOXICOLOGY
Volume 60, Issue 3, Pages 406-407Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/15563650.2021.1953519
Keywords
End-stage kidney disease; metformin; metabolic acidosis; encephalopathy; lentiform nucleus
Categories
Funding
- Yin Yen-Liang Foundation Development and Construction Plan of the School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan [107F-M01-0504]
- Ministry of Science and Technology, Taipei, Taiwan [MOST 109-2314-B-010-053-MY3, MOST 109-2321-B-009007, MOST 109-2811-B-010-532, MOST 110-2811-B-010-510]
- Taipei Veterans General Hospital, Taipei, Taiwan [VGHUST109-V5-1-2, V110C-194]
- Center for Intelligent Drug Systems and Smart Biodevices (IDS2B) from The Featured Areas Research Center Program, MOE in Taiwan
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This case report illustrates a patient with end-stage kidney disease who developed metformin-induced encephalopathy, presenting with characteristic brain imaging findings and neurological symptoms, which improved with intensive hemodialysis and discontinuation of the drug.
This case report describes a 56-year-old woman receiving regular hemodialysis for three years who presented with an unsteady gait for one month, dysarthria, and frequent choking on liquids for two weeks. Brain MRI revealed a characteristic lentiform fork sign with hyperintense T2W/FLAIR signal in the bilateral lentiform nuclei and restricted diffusion in bilateral globus pallidus. She was inadvertently prescribed metformin 1,000 mg per day one month ago by a physician who was unaware of her end-stage kidney disease. After intensive hemodialysis therapy with eight hemodialysis sessions within 12 days, her neurological deficits fully resolved. Clinicians should be aware of metformin-induced encephalopathy, presenting with relevant medication history, neurological symptoms, and the lentiform fork sign.
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