Metformin-related lactic acidosis in patients with acute kidney injury.
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.
Devetzis
Vassilios
V
Division of Nephrology, University Hospital of Alexandroupolis, Faculty of Medicine, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece. vasdeve@yahoo.gr
Passadakis
Ploumis
P
Panagoutsos
Stelios
S
Theodoridis
Marios
M
Thodis
Elias
E
Georgoulidou
Anastasia
A
Vargemezis
Vassilis
V
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
D007004:Hypoglycemic Agents; D008687:Metformin