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In a case series, three patients (two men and a woman), aged 60-86, were described who developed lactic acidosis, hyperlactataemia, circulatory shock, multiple organ dysfunction syndrome and/or myocardial infarction while receiving metformin. One patient additionally developed Interstitial nephritis while receiving cefuroxime [routes, dosages and durations of treatments to reaction onsets not stated; not all outcomes stated].
A 60-year-old man, with type 2 diabetes mellitus, had been receiving metformin. He was hospitalised for scheduled right knee joint replacement. He received cefuroxime as perioperative antibiotic prophylaxis. On postoperative day 2, he developed itchy rash of urticarial character over the whole body. The cefuroxime therapy was ceased. He received treatment with antihistamines. On the fourth postoperative day, he experienced syncope/collapse with a fall. On the following day, he developed nausea, and vomited many times. On the sixth postoperative day, he developed dyspnoea at rest, desaturation, tachypnoea, hypotension and sweating. He was found pale with cold areas. He was shifted to the ICU. His circulatory and ventilatory instability progressed over the next few hours. Laboratory tests revealed severe metabolic acidosis and hyperlactataemia....