[Metformin-associated lactic acidosis remains a serious complication of metformin therapy].
We report 4 cases of lactic acidosis in diabetic patients usually treated with metformin. For the first 3 patients, the clinical history was similar because lactic acidosis was precipitated by gastro-intestinal disorders whereas all of them were simultaneously treated with several nephrotoxic drugs. These 3 patients presented with acute renal failure on arrival at hospital. Their issue was fatal whereas any obvious cause of overproduction of lactate was found. The fourth case, which was due to a voluntary intoxication, was the only one presenting with a favourable evolution. The metformin plasma and red blood cell levels were performed for 2 of 4 patients and confirmed the overdose. These observations remind that metformin-associated lactic acidosis remains a serious complication, and that medical doctors must respect strictly contra-indications and guidelines for withdrawing metformin.
Orban
J C
JC
Service de réanimation, département d'anesthésie-réanimation Est, hôpital Saint-Roch, 5, rue Pierre-Dévoluy, CHU de Nice, 06006 cedex 1, Nice, France.
Giunti
C
C
Levraut
J
J
Grimaud
D
D
Ichai
C
C
D000140:Acidosis, Lactic / Q000097:blood / Q000139:chemically induced* / Q000503:physiopathology; D058186:Acute Kidney Injury / Q000097:blood / Q000150:complications; D000328:Adult; D000368:Aged; D048909:Diabetes Complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D004417:Dyspnea / Q000139:chemically induced; D004912:Erythrocytes / Q000378:metabolism; D017809:Fatal Outcome; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D006323:Heart Arrest / Q000150:complications / Q000503:physiopathology; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D019344:Lactic Acid / Q000096:biosynthesis / Q000097:blood; D008297:Male; D008687:Metformin / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D008875:Middle Aged; D009765:Obesity
D007004:Hypoglycemic Agents; D019344:Lactic Acid; D008687:Metformin