title: Lactic acidosis. Lactic acidosis associated with metformin use in treatment of type 2 diabetes mellitus.
abstract: Metformin, an antihyperglycemic, is widely used in the treatment of type 2 diabetes mellitus (DM). A rare, but important complication associated with this drug is the development of lactic acidosis: Overall mortality of lactic acidosis is approximately 50%. Certain subsets of patients taking metformin are at greater risk of developing lactic acidosis. This report discusses the development of metformin-associated lactic acidosis in four older adults admitted to an institution during a 2-month period, treatments, and outcomes. We recommend an aggressive treatment strategy of hemodialysis followed by peritoneal dialysis, continuous bicarbonate infusion, and tight glucose control. We review the cautions and contraindications of metformin use for the treatment of type 2 DM and report an educational plan for residents and staff instituted to improve drug complication awareness and reduce mortality.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Brown Medical School/Memorial Hospital of Rhode Island, USA.
authors.forename: Vera A
authors.initials: VA
authors.lastname: DePalo
authors.forename: Karen
authors.initials: K
authors.lastname: Mailer
authors.forename: David
authors.initials: D
authors.lastname: Yoburn
authors.forename: Robert S
authors.initials: RS
authors.lastname: Crausman
mesh_terms: D000140:Acidosis, Lactic / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007262:Infusions, Intravenous; D008297:Male; D008687:Metformin / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D007004:Hypoglycemic Agents; D017693:Sodium Bicarbonate; D008687:Metformin