title: Management of metformin-associated lactic acidosis by continuous renal replacement therapy.
abstract: BACKGROUND
  Metformin-associated lactic acidosis (MALA) is a severe metabolic failure with high related mortality. Although its use is controversial, intermittent hemodialysis is reported to be the most frequently used treatment in conjunction with nonspecific supportive measures. Our aim was to report the evolution and outcome of cases managed by continuous renal replacement therapy (CRRT).
  
  
  RESULTS
  Over a 3-year period, we retrospectively identified patients admitted to the intensive care unit for severe lactic acidosis caused by metformin. We included patients in our study who were treated with CRRT because of shock. We describe their clinical and biological features at admission and during renal support, as well as their evolution. We enrolled six patients with severe lactic acidosis; the mean pH and mean lactate was 6.92±0.20 and 14.4±5.1 mmol/l, respectively. Patients had high illness severity scores, including the Simplified Acute Physiology Score II (SAPS II) (average score 63±12 points). Early CRRT comprised either venovenous hemofiltration (n = 3) or hemodiafiltration (n = 3) with a mean effluent flow rate of 34±6 ml/kg/h. Metabolic acidosis control and metformin elimination was rapid and there was no rebound. Outcome was favorable in all cases.
  
  
  CONCLUSIONS
  Standard use of CRRT efficiently treated MALA in association with symptomatic organ supportive therapies.
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Réanimation Médicale, Lyon, France.
authors.forename: Geoffray
authors.initials: G
authors.lastname: Keller
authors.forename: Martin
authors.initials: M
authors.lastname: Cour
authors.forename: Romain
authors.initials: R
authors.lastname: Hernu
authors.forename: Julien
authors.initials: J
authors.lastname: Illinger
authors.forename: Dominique
authors.initials: D
authors.lastname: Robert
authors.forename: Laurent
authors.initials: L
authors.lastname: Argaud
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007773:Lactates / Q000378:metabolism; D008297:Male; D008687:Metformin / Q000009:adverse effects*; D008875:Middle Aged; D017582:Renal Replacement Therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D007773:Lactates; D008687:Metformin