Endocrinol Metab.  2015 Mar;30(1):78-83. 10.3803/EnM.2015.30.1.78.

Metformin-Associated Lactic Acidosis: Predisposing Factors and Outcome

• Kim MJ
• Han JY
• Shin JY
• Kim SI
• Lee JM
• Hong S
• Kim SH
• Nam MS
• Kim YS

• KMID: 2407108
• DOI: http://doi.org/10.3803/EnM.2015.30.1.78

Abstract

BACKGROUND
Metformin is considered the first choice oral treatment for type 2 diabetes patients in the absence of contraindications. Rarely, life-threatening complications associated with metformin treatment are seen in some patients with underlying diseases. The aim of this study was to further investigate the clinical profiles and risk factors for metformin-associated lactic acidosis (MALA) and the treatment modalities according to survival.
METHODS
To identify MALA, we performed a retrospective study in seven diabetic patients who were taking metformin and had been diagnosed with lactic acidosis at Inha University Hospital between 1995 and 2012. For each patient, we recorded the age, sex, daily metformin dosage, laboratory test results, admission diagnosis, and risk factors. Also, concurrent conditions, treatment modalities, and outcomes were evaluated.
RESULTS
Six patients had risk factors for lactic acidosis before admission. All patients had renal impairment on admission as a precipitating risk factor. Five patients survived and two patients died despite early renal replacement therapy. Older patients tended to have a poorer prognosis.
CONCLUSION
Renal function must be monitored in elderly type 2 diabetes mellitus patients with underlying diseases and conditions causing renal impairment who begin metformin treatment. Accurate recognition of MALA and initiation of renal replacement are essential for treatment.

Keyword

Metformin; Acidosis, lactic; Diabetes mellitus, type 2

MeSH Terms

Acidosis, Lactic*
Aged
Causality*
Diabetes Mellitus, Type 2
Diagnosis
Humans
Metformin
Prognosis
Renal Replacement Therapy
Retrospective Studies
Risk Factors
Metformin

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