title: Metformin-associated lactic acidosis after elective cervical spine fusion: a case report.
abstract: METHODS
  A case of metformin-associated lactic acidosis after elective spinal surgery is reported.
  
  
  OBJECTIVE
  To inform spinal surgeons of this potentially fatal side effect and make them aware that metformin should be stopped 48 hours before surgery.
  
  
  BACKGROUND
  Metformin is a commonly used oral hypoglycemic agent used in the treatment of non-insulin-dependent diabetes mellitus. A rare side effect of metformin is lactic acidosis, which has a 50% mortality rate. Risk factors for metformin-associated lactic acidosis include renal, hepatic, and cardiac failure. Two cases have been reported in postsurgical patients. No cases of this disorder have been reported after orthopedic procedures.
  
  
  METHODS
  A patient who developed metformin-associated lactic acidosis after cervical spinal fusion is presented.
  
  
  RESULTS
  Recognition of the cause and aggressive medical management led to resolution of the lactic acidosis. Subsequent surgery was uneventful when metformin was discontinued more than 48 hours before surgery.
  
  
  CONCLUSIONS
  Spinal surgeons should be aware of this preventable, potentially fatal side effect and stop metformin 48 hours before surgery.
authors.affiliation: R. Adams Cowley Shock Trauma Center, University of Maryland Medical Systems, Baltimore, USA.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Mears
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Lipsett
authors.forename: Myles D
authors.initials: MD
authors.lastname: Brager
authors.forename: Lee H
authors.initials: LH
authors.lastname: Riley
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D008297:Male; D008687:Metformin / Q000009:adverse effects*; D018908:Muscle Weakness / Q000209:etiology; D011183:Postoperative Complications / Q000139:chemically induced / Q000175:diagnosis; D013123:Spinal Fusion / Q000009:adverse effects; D013130:Spinal Stenosis / Q000601:surgery
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin