title: Metformin-related lactic acidosis in patients with acute kidney injury.
abstract: BACKGROUND
  Metformin is nowadays considered as first-line therapy in individuals with non-insulin dependent diabetes mellitus (NIDDM). Metformin-related lactic acidosis (MALA) occurs more frequently after inappropriate use especially in patients with acute kidney injury (AKI) or chronic kidney disease (CKD). Thus, its prescription in these patients is contraindicated, while the role of dialysis is under evaluation.
  
  
  METHODS
  We describe two cases of severe metformin-related lactic acidosis with underlying acute kidney injury, which were treated with dialysis.
  
  
  RESULTS
  In both cases, lactic acidosis occurred on a background of acute decline in renal function, possibly due to drug accumulation. It is interesting that metformin was contraindicated in one case.
  
  
  CONCLUSIONS
  Lactic acidosis is a rare but potentially fatal adverse effect of metformin, particularly in patients with AKI, which should always be considered in clinical practice. Dialysis seems to contribute significantly to the management of this life-threatening condition and the improvement in outcome.
authors.affiliation: Division of Nephrology, University Hospital of Alexandroupolis, Faculty of Medicine, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece. vasdeve@yahoo.gr
authors.forename: Vassilios
authors.initials: V
authors.lastname: Devetzis
authors.forename: Ploumis
authors.initials: P
authors.lastname: Passadakis
authors.forename: Stelios
authors.initials: S
authors.lastname: Panagoutsos
authors.forename: Marios
authors.initials: M
authors.lastname: Theodoridis
authors.forename: Elias
authors.initials: E
authors.lastname: Thodis
authors.forename: Anastasia
authors.initials: A
authors.lastname: Georgoulidou
authors.forename: Vassilis
authors.initials: V
authors.lastname: Vargemezis
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000150:complications / Q000628:therapy; D058186:Acute Kidney Injury / Q000150:complications / Q000628:therapy*; D000368:Aged; D000075202:Contraindications; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008687:Metformin / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D006435:Renal Dialysis
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin