Metformin and lactic acidosis in patients with type 2 diabetes--from pride and prejudice to sense and sensibility.
OBJECTIVE
To present the cases of lactic acidosis encountered in our department among metformin-treated type 2 diabetic patients and to investigate the role of contraindications to metformin use.


METHODS
A survey of medical records of metformin-treated type 2 diabetic patients hospitalised for various medical conditions during the years 2004-2005 who exhibited elevated serum concentrations of lactic acid.


RESULTS
Seven metformin-treated type 2 diabetic patients were identified who were not attending our department and were hospitalised with elevated serum lactic acid levels (6 developed lactic acidosis). All patients had one or more contraindications to metformin use. Outcome was favourable in 6 patients, while 1 patient with hepatocellular carcinoma died of liver failure.


CONCLUSIONS
So far, metformin is one of the safest first-line oral hypoglycaemic agents. However, caution is needed to avoid patients with evident contraindications. This highlights the need for the practitioner to possess sound clinical judgement when prescribing metformin.
Papanas
N
N
Second Department of Internal Medicine, Democritus University of Thrace, Greece. papanasnikos@yahoo.gr
Monastiriotis
C
C
Christakidis
D
D
Maltezos
E
E