title: Metformin-associated lactic acidosis in an intensive care unit.
abstract: BACKGROUND
  Metformin-associated lactic acidosis (MALA) is a classic side effect of metformin and is known to be a severe disease with a high mortality rate. The treatment of MALA with dialysis is controversial and is the subject of many case reports in the literature. We aimed to assess the prevalence of MALA in a 16-bed, university-affiliated, intensive care unit (ICU), and the effect of dialysis on patient outcome.
  
  
  METHODS
  Over a five-year period, we retrospectively identified all patients who were either admitted to the ICU with metformin as a usual medication, or who attempted suicide by metformin ingestion. Within this population, we selected patients presenting with lactic acidosis, thus defining MALA, and described their clinical and biological features.
  
  
  RESULTS
  MALA accounted for 0.84% of all admissions during the study period (30 MALA admissions over five years) and was associated with a 30% mortality rate. The only factors associated with a fatal outcome were the reason for admission in the ICU and the initial prothrombin time. Although patients who went on to haemodialysis had higher illness severity scores, as compared with those who were not dialysed, the mortality rates were similar between the two groups (31.3% versus 28.6%).
  
  
  CONCLUSIONS
  MALA can be encountered in the ICU several times a year and still remains a life-threatening condition. Treatment is restricted mostly to supportive measures, although haemodialysis may possess a protective effect.
authors.affiliation: Service de Néphrologie, CHU Brabois; Vandoeuvre les Nancy, 54500, France. n.peters@chu-nancy.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Peters
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jay
authors.forename: Damien
authors.initials: D
authors.lastname: Barraud
authors.forename: Aurélie
authors.initials: A
authors.lastname: Cravoisy
authors.forename: Lionel
authors.initials: L
authors.lastname: Nace
authors.forename: Pierre-Edouard
authors.initials: PE
authors.lastname: Bollaert
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gibot
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced / Q000453:epidemiology* / Q000401:mortality; D000368:Aged; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007362:Intensive Care Units; D008297:Male; D008485:Medical Audit; D008687:Metformin / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin