Metformin -associated lactic acidosis

Czech version

Authors: Martina Lášticová; Jakub Víšek; Ondřej Zima; Alena Šmahelová; Vladimír Bláha
Authors‘ workplace: III. interní gerontometabolická klinika Fakultní nemocnice Hradec Králové
Published in: Vnitř Lék 2020; 66(7): 438-442
Category: Case Report

Overview

Lactic acidosis is a feared complication of metformin therapy. In our article we describe 2 case reports of patients treated with metformin, who developed this complication. In the first case, which was fatal, cummulation of lactate was a result of acute kidney failure caused by diarrhea. In the second patient, lactic acidosis developed in the terrain of preexisting chronic kidney disease, when dyspepsia and decreased fluid intake caused progression into acute kidney failure. In this case, treatment of lactic acidosis was successful. Death of the first patient was probably caused by the presence of serious comorbidities and other complications which developed early after her addmission to intensive care unit. Lactic acidosis can be prevented by strict avoidance of metformin use in case of contraindications and interruption of its use during intercurrent disease.

Keywords:

type 2 diabetes mellitus – metformin – lactic acidosis – renal failure

Sources

1. Bailey CJ, Turner RC. Metformin. N Engl J Med 1996; 334–574.

2. Howlett HC, Bailey CJ. A risk- benefit assessment of metformin in type 2 diabetes mellitus. Drug Saf 1999; 20: 489.

3. Graham GG, Punt J, Arora M, et al. Clinical Pharmacokinetics of metformin. Clin Pharmacokinet 2011; 50: 81.

4. Duong JK, Furlong TJ, Roberts DM, et al. The Role of Metformin in Metformin -Associated Lactic Acidosis (MALA): Case Series and Formulation of a Model of Pathogenesis. Drug Saf 2013; 36: 733.

5. Bailey CJ, Wilcock C, Day C. Effect of metformin on glucose metabolism in the splanchnic bed. Br J Pharmacol 1992; 105: 1009.

6. Vecchio S, Giampreti A, Petrolini VM, et al. Metformin accumulation: lactic acidosis and high plasmatic metformin levels in a retrospective case series of 66 patients on chronic therapy. Clin Toxicol (Phila) 2014; 52: 129

7. DeFronzo R, Fleming GA, Chen K, et al. Metformin- associated lactic acidosis: current perspectives on causes and risk. Metabolism 2016; 65(2): 20–29.

8. Lalau JD, Race JM. Lactic acidosis in metformin- treated patients. Prognostic value of arterial lactate levels and plasma metformin concentrations. Drug Saf 1999; 20: 377.

9. Seidowsky A, Nseir S, Houdret N, Fourrier F. Metformin -associated lactic acidosis: a prognostic and therapeutic study. Crit Care Med 2009; 37: 2191.

10. Lalau JD, Andrejak M, Morinière P, et al. Hemodialysis in the treatment of lactic acidosis in diabetics treated by metformin: a study of metformin elimination. Int J Clin Pharmacol Ther Toxicol 1989; 27: 285.

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

12. Salpeter SR, Greyber E, Pasternak GA, et al. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst. Rev. 2010;1: CD002967.

13. Lalau JD, Race JM. Lactic acidosis in metformin therapy: searching for a link with metformin in reports of „metformin- associated lactic acidosis“. Diabetes Obes Metab 2001; 3: 195–201.

14. Lalau JD Arnouts P, Sharif A, et. al. Metformin and other antidiabetic agents in renal failure patients. Kidney Int. 2015; 87(2): 308–322.