Metformin-associated Severe Lactic Acidosis in the Setting of Acute Kidney Injury (original) (raw)
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Metformin-related lactic acidosis in patients with acute kidney injury
International Urology and Nephrology, 2011
Metformin is nowadays considered as first-line therapy in individuals with non-insulin dependent diabetes mellitus (NIDDM). Metformin-related lactic acidosis (MALA) occurs more frequently after inappropriate use especially in patients with acute kidney injury (AKI) or chronic kidney disease (CKD). Thus, its prescription in these patients is contraindicated, while the role of dialysis is under evaluation. We describe two cases of severe metformin-related lactic acidosis with underlying acute kidney injury, which were treated with dialysis. In both cases, lactic acidosis occurred on a background of acute decline in renal function, possibly due to drug accumulation. It is interesting that metformin was contraindicated in one case. Lactic acidosis is a rare but potentially fatal adverse effect of metformin, particularly in patients with AKI, which should always be considered in clinical practice. Dialysis seems to contribute significantly to the management of this life-threatening condition and the improvement in outcome.
Metformin Induced Lactic Acidosis and Acute Renal Failure
Medico Research Chronicles
Metformin is a biguanide agent and oral antihyperglycemic agent used in the treatment of type 2 diabetes mellitus. Metformin-associated lactic acidosis and acute renal failure is a very rare but life-threatening side effect of metformin. We present the case of a nondiabetic 41 years old woman, who attempted to commit suicide by ingesting more than 20 grams of metformin. She presented with lactic acidosis and acute renal failure to the emergency department. She was successfully treated by hemodialysis. The main treatment method is hemodialysis who presents with lactic acidosis and acute renal failure in metformin intoxication.
Diabetic Medicine, 2012
Diabet. Med. 29, 245–250 (2012)Introduction Metformin is a biguanide anti‐hyperglycaemic drug. Metformin‐associated lactic acidosis may sometimes be life‐threatening. Continuous renal replacement therapy has been suggested as a method for resolving this extremely dangerous metabolic state. We describe the history of six patients admitted to the intensive care unit over a 28‐month period in pre‐shock conditions because of severe lactic acidosis, attributed to metformin‐associated lactic acidosis, and successfully treated.Methods We reviewed the charts of six patients admitted to our intensive care unit between January 2008 and May 2010. After initial assessment, all patients were treated with continuous renal replacement therapy. Admission serum lactate and creatinine levels, pH, need for ventilatory and cardiovascular support, as well as continuous renal replacement therapy details and length of stay were reviewed.Results Admission pH levels of the six patients ranged between pH ...
Metformin-Associated Acute Kidney Injury and Lactic Acidosis
International Journal of Nephrology, 2011
Objectives. Metformin is the preferred oral antidiabetic agent for type 2 diabetes. Lactic acidosis is described as a rare complication, usually during an acute kidney injury (AKI).Material and Methods. We conducted a prospective observational study of metformin-associated AKI cases during four years. 29 cases were identified. Previous renal function, clinical data, and outcomes were recorded.Results. An episode of acute gastroenteritis precipitated the event in 26 cases. Three developed a septic shock. Three patients died, the only related factor being liver dysfunction. More severe metabolic acidosis hyperkalemia and anemia were associated with higher probabilities of RRT requirement. We could not find any relationship between previous renal dysfunction and the outcome of the AKI.Conclusions. AKI associated to an episode of volume depletion due to gastrointestinal losses is a serious complication in type 2 diabetic patients on metformin. Previous renal dysfunction (mild-to-moderat...
Clinical Toxicology, 2019
Background: Metformin-associated lactic acidosis (MALA) and metformin-induced lactic acidosis (MILA) remain controversial entities. Metformin toxic effect depends on accumulation to lead to lactic acidosis (LA), particularly during an episode of acute kidney injury (AKI). In MILA, no other condition contributing to LA is found. The aims of this study were to describe the characteristics and prognosis of AKI associated with LA in metformin users and to clarify the role of this drug in the different types of LA. Methods: We performed a French multicenter retrospective study in diabetic patients treated by metformin presenting with LA in a context of AKI in 2015. 126 nephrology units (NU) and 23 intensive care units (ICU) were contacted. We individualized MILA and MALA patients in order to illustrate the role of metformin. Results: We included 173 patients (109 MILA, 64 MALA). 103 patients presented without hemodynamic instability (82 MILA and 21 MALA) whereas 70 patients were shocked including 27 MILA. The shock was associated with death with an odds ratio (OR) of 12.92 (p < .001). Digestive disorders (DD) were strongly associated with MILA (p ¼ .0001). MALA was significantly associated with shock (p < .0001). The mortality rate was higher in MALA (26%) when compared with MILA (7%). Dialysis performed in 133 patients was significantly associated with shock, kalemia, lactate and serum creatinine levels. In multivariate analysis, metformin level was independently associated with pH or lactate level only in MILA patients. Conclusions: MILA is associated with DD and death is due to severe refractory acidosis leading to cardiovascular collapse attributed to metformin accumulation mainly via AKI. MALA patients are more frequently shocked and death is related to their underlying condition, metformin accumulation increasing LA.
Metformin-associated lactic acidosis treated with prolonged hemodialysis
American Journal of Emergency Medicine, 2011
Metformin-associated lactic acidosis is a well-recognized complication in diabetic patients receiving metformin. Only a few cases of voluntary metformin intoxication presented with metformin-associated lactic acidosis have been reported, and they mostly described patients with diabetes mellitus. Cases of voluntary acute metformin intoxication in nondiabetic, previously healthy subjects are rarely reported, and their characteristics and prognosis are less known. We report a 34-year-old healthy man who presented to the emergency department after taking 170 metformin 850-mg tablets in a suicide attempt. The patient developed severe lactic acidosis and acute renal failure, which were completely resolved after prolonged hemodialysis.
Extreme lactic acidosis type B associated with metformin treatment
NDT Plus, 2011
The elimination of metformin is exclusively through the kidneys and elevated plasma concentrations can cause lactic acidosis. We report a case of severe lactic acidosis (pH 6.60) occuring with ostensibly normal therapeutic doses of metformin in the setting of acute renal failure. Continuous veno-venous haemodiafiltration decreased plasma metformin concentrations from 266 lmol/L at presentation to 68 lmol/L, 21 h later. The patient improved rapidly.
BMC nephrology, 2018
Metformin associated lactic acidosis (MALA) is a well-known serious side effect of biguanides. However, the best treatment strategy remains a matter of debate. In the last 14 years, we observed a significant increase in hospitalizations for MALA to our Center. We report the outcomes of our clinical and therapeutic approach. This is a single-center case series. Twenty-eight patients affected with MALA and acute kidney failure admitted between January 2000 and September 2014 were included. We analyzed comorbidities, laboratory tests and clinical parameters at admission, at 36 h and at discharge. All patients were treated with sustained low-efficiency dialysis (SLED) until normalization of serum lactate (≤ 3 mmol/L), bicarbonate (between 20 and 25 mmol/L) and potassium (between 4.0 and 5.1 mmol/L). The mortality rate was 21.4%, with all of the events occurring within 24 h from admission, and before or during the first hemodialysis treatment. Precipitating causes included; acute dehydra...
Unexpected survival from severe metformin-associated lactic acidosis
The Netherlands Journal of Medicine
Lactic acidosis is a recognised complication of the antihyperglycaemic biguanide agent metformin, especially in patients with renal failure. We report a case of severe lactic acidosis and hypothermia due to metformin treatment and renal impairment. The favourable outcome despite extremely unfavourable clinical signs and symptoms for survival after admission and initial treatment was unexpected. Specific aspects of the clinical course are addressed.
Lactic acidosis induced by metformin in a chronic hemodialysis patient with diabetes mellitus type 2
Hemodialysis International, 2013
Metformin is a biguanide group oral antidiabetic drug used for the treatment of type 2 diabetes mellitus. Nausea, vomiting, diarrhea, abdominal pain, and anorexia are the most common adverse effects encountered during treatment. Lactic acidosis is a serious side effect seen with metformin use, and while the incidence of lactic acidosis is similar to other oral antidiabetics, metformin is not recommended to patients with certain risk factors, such as cardiovascular, pulmonary, and renal and liver failure. We describe a chronic hemodialysis patient treated with metformin, presenting to the nephrology department with altered mental status.