title: Lactic Acidosis in a Patient with Type 2 Diabetes Mellitus.
abstract: Lactic acidosis occurs when lactate production exceeds its metabolism. There are many possible causes of lactic acidosis, and in any given patient, several causes may coexist. This Attending Rounds presents a case in point. Metformin's role in the pathogenesis of lactic acidosis in patients with diabetes mellitus is complex, as the present case illustrates. The treatment of lactic acidosis is controversial, except for the imperative to remedy its underlying cause. The use of sodium bicarbonate to treat the often alarming metabolic derangements may be quite efficacious in that regard but is of questionable benefit to patients. Renal replacement therapies (RRTs) have particular appeal in this setting for a variety of reasons, but their effect on clinical outcomes is untested.
authors.affiliation: Division of Nephrology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, New Jersey Weisberg-Lawrence@CooperHealth.edu.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Weisberg
mesh_terms: D000136:Acid-Base Equilibrium; D000140:Acidosis, Lactic / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D017809:Fatal Outcome; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D008297:Male; D008687:Metformin / Q000009:adverse effects*; D008875:Middle Aged; D006435:Renal Dialysis; D017693:Sodium Bicarbonate / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D007004:Hypoglycemic Agents; D017693:Sodium Bicarbonate; D008687:Metformin
keywords: acidosis; congestive heart failure; diabetes mellitus; dialysis; intoxication