title: Severe acidosis in patients taking metformin--rapid reversal and survival despite high APACHE score.
abstract: BACKGROUND
  Metformin has been shown to reduce complications and mortality from Type 2 diabetes mellitus, and is increasingly used to treat this condition. This agent is, however, associated with a rare but serious risk of lactic acidosis.
  
  
  METHODS
  We present cases of 10 patients with Type 2 diabetes mellitus who developed acute renal failure and severe lactic acidosis. Despite the severity of their illness, all patients but one survived.
  
  
  CONCLUSIONS
  The increasing prevalence of Type 2 diabetes and its treatment with metformin might result in more cases of lactic acidosis. However our case report demonstrates that early and aggressive treatment with haemofiltration can improve outcomes even in the presence of severe acidosis.
authors.affiliation: Metabolic Unit, Western General Hospital, Edinburgh, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Nyirenda
authors.forename: T
authors.initials: T
authors.lastname: Sandeep
authors.forename: I
authors.initials: I
authors.lastname: Grant
authors.forename: G
authors.initials: G
authors.lastname: Price
authors.forename: J A
authors.initials: JA
authors.lastname: McKnight
mesh_terms: D018806:APACHE; D000140:Acidosis, Lactic / Q000139:chemically induced*; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000150:complications; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D004630:Emergencies; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D015996:Survival Rate
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin