title: Metformin-Associated Lactic Acidosis in a Patient with Normal Renal Function.
abstract: We report a case of metformin-associated lactic acidosis (MALA) in the setting of normal renal function and review the relevant medical literature. A 77-year-old female diagnosed with type 2 diabetes mellitus previously treated with insulin and gliclazide MR was started on metformin. A few weeks later, she was found to have lactic acidosis. Renal function was normal, and no severe underlying illness was identified. Metformin was discontinued, and lactate levels normalized within 4 days, suggesting metformin was a reversible precipitant of the lactic acidosis. MALA can occur in the absence of renal impairment, systemic hypoperfusion or severe liver disease. A possible mechanism is a genetically determined alteration in metformin pharmacokinetics. Metformin is beneficial and safe in patients with normal renal function, but the development of MALA, although rare, should be kept in mind to prevent potentially life-threatening toxicity.
authors.affiliation: Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Omar
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: Ellen
authors.affiliation: Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Biochemistry, Microbiology & Immunology, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: asorisky@ohri.ca.
authors.forename: Alexander
authors.initials: A
authors.lastname: Sorisky
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced*; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D019344:Lactic Acid / Q000378:metabolism; D008687:Metformin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D019344:Lactic Acid; D008687:Metformin
keywords: acidose lactique; agent antihyperglycémiant oral; diabète de type 2; fonction rénale; lactic acidosis; metformin; metformine; oral antihyperglycemia agent; renal function; type 2 diabetes