title: Monitoring of metformin-induced lactic acidosis in a diabetic patient with acute kidney failure and effect of hemodialysis.
abstract: Metformin associated lactic acidosis (MALA) is a serious complication occurring especially in elderly patients given high doses of the drug. We report a non-fatal case of MALA with pronounced acidosis (pH 6.76, lactate 30.81 mmol/l) and high metformin concentrations (127 mg/l) in a patient who had developed acute renal failure after undergoing an operation. Multiple measurements of biological parameters and metformin blood concentrations showed the effectiveness of repeated hemodialysis sessions on metformin elimination. Cases previously reported with such a severe MALA were associated with a high mortality rate. We show that close monitoring in an intensive care unit together with prompt and repeated dialysis sessions can lead to a favorable outcome.
authors.affiliation: Department of Pharmacology-Toxicology-Pharmacovigilance, Dupuytren Hospital, Limoges, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Laforest
authors.forename: Franck
authors.initials: F
authors.lastname: Saint-Marcoux
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Amiel
authors.forename: Nicolas
authors.initials: N
authors.lastname: Pichon
authors.forename: Louis
authors.initials: L
authors.lastname: Merle
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000150:complications / Q000628:therapy*; D058186:Acute Kidney Injury / Q000150:complications / Q000628:therapy*; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects; D007362:Intensive Care Units; D008687:Metformin / Q000009:adverse effects*; D008991:Monitoring, Physiologic / Q000379:methods*; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin