A serious diagnosis in geriatric patient – metformin-associated lactic acidosis. Do we consider it sufficiently?

Czech version

Authors: Zdeněk Bureš; David Albrecht
Authors‘ workplace: III. interní gerontometabolická klinika LF UK a FN Hradec Králové
Published in: Geriatrie a Gerontologie 2021, 10, č. 2: 92-100
Category:

Overview

Metformin is an oral antidiabetic drug of first choice with a positive effect on type 2 diabetes mellitus control as well as protective action on cardiovascular system. With respect to renal impairment, metformin should be prescribed in reduced doses or is even contraindicated due to high risk of metformin accumulation and/or lactic acidosis development. Till this day, this complication remains a risk especially in geriatric patients with reduced reserve capacity, who often suffer from numerous chronic diseases which can deteriorate due to a minor event. This fact should be remembered by every doctor, who should also be able to decide whether to terminate metformin therapy or not. In this article we present case studies of four patients of metabolic ICU treated with metformin-associated lactic acidosis.

Sources

1. Karen I, Svačina Š, Jurašková B. Diabetes mellitus, léčba u starších pacientů v ČR. Doporučený diagnostický a terapeutický postup pro všeobecné praktické lékaře. Geri a gero 2019; 2 78–95.

2. EMA/868987/2016. Use of metformin to treat diabetes now expanded to patients with moderately reducedkidneyfunction. Dostupné z: www.ema.europa.eu/medicines/ human/referrals/metformin-metformin- containing-medicines.

3. Nováková M. Geriatrický pacient v dialyzační péči – zkušenosti z Centra následné péče FN Motol. Geri a gero 2018; 7(1): 17–20.

4. Borbély Z. Chronická obličková choroba, metformín a laktátová acidóza. Vnitř Lék 2016; (2): 299– 303.

5. Weber P, Meluzínová H, Prudius D. Diabetes mellitus – geriatrické syndromy, cíle a možnosti léčby ve vyšším věku. Geri a gero 2014; (4): 194–198.

6. Kruse O, Grunnet N, Barfod C. Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: a systematic review. Scand J Trauma Resusc Emerg Med 2011; (19).

7. Šmahelová A. Metformin a ledviny. Vnitř Lék 2008; (5): 535–540.

8. DeFronzo R, Alexander Fleming G, Chen K, Bicsak TA. Metformin- associated lactic acidosis: Current perspectives on causes and risk. Metabolism 2015; (2): 20–29.

9. Inzucchi SE, Lipska KJ, Mayo H, et al. Metformin in patients with type 2 diabetes and kidney disease: a systematic review. JAMA 2014; (24): 2668–2675.

10 Kezerle, L, Shaleva L, Barski L. Treating the elderly diabetic patient: special considerations. Diabetes Metab Syndr Obes 2014; 7: 391–400.

11. van Berlo-van de Laar IR, Vermeij CG, Doorenbos CJ. Metformin associated lactic acidosis: incidence and clinical correlation with metformin serum concentration measurements. J Clin Pharm Ther 2011; 36(3): 376– 382.

12. Onder G, Ortolani E, Pellizzari L. Metformina nell’anziano diabetico: gallina vecchia fa buon brodo. Focus Farmacovigilanza 2016; (3): 9–11.

13. Kubát K, Zbořil M, Semrádová M, Kaňák V. 23 případů metforminem indukované metabolické laktátové acidózy. Klinická Biochemie a Metabolismus 2017; (2): 77–85.

14. Karvunidis, T, Harazím M, Raděj J, et al. Laktátová acidóza asociovanás metforminem–minireview na podkladě kazuistik. Anesteziologie a intenzivní medicína 2016; (4): 243–251.

15. Lalau JP, Arnouts P, Sharif A, De Broe ME. Metformin and other antidiabetic agents in renal failure patients. Kidney Int 2015; (2): 308–322.

16. Uličiansky V, Schroner Z. Metformín u pacientov s chronickým obličkovým a kardiovaskulárnym ochorením. Diabetes a obezita 2019; (37): 45–53.