Metformin-associated lactic acidosis treated with prolonged hemodialysis

Akoglu, Hadim; Akan, Belgin; Piskinpasa, Serhan; Karaca, Ömer; Dede, Fatih; Erdem, Deniz; Albayrak, Mahinur Demet; Odabaş, Ali Rıza

doi:10.1016/j.ajem.2010.06.005

Cited by 14 publications

(17 citation statements)

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“…This remains true even among those patients with relative contraindications, although use of metformin in this group should be done with caution (Table 1) [4]. While the incidence of MALA is low, its mortality is reported to approach 50 % [2,12,15,16,19,24,26]. The estimated incidence of lactic acidosis in chronic users of metformin is between three and nine cases per 100,000 patients-years [1,3,10,13,15,27].…”

Section: How Does Metformin Lead To the Development Of Lactic Acidosimentioning

confidence: 99%

“…Reported ingestions treated with hemodialysis have been as high as 145 g [15]. Patients may present along a clinical spectrum, and metformin levels do not correlate well to symptoms, although higher metformin levels tend to be associated with more severe lactic acidosis [7].…”

Section: How Does Metformin Lead To the Development Of Lactic Acidosimentioning

confidence: 99%

“…Subtype B2 refers to a metabolic state induced by toxins. Finally, the third subtype, B3 is a result of inborn errors of metabolism [11,15,18,19]. Initially, MALA is considered a type B lactic acidosis.…”

Section: How Does Metformin Lead To the Development Of Lactic Acidosimentioning

confidence: 99%

“…Lactic acidosis is defined as a metabolic acidosis with a pH of less than 7.35 and a lactate concentration greater than 5 mmol/L [15][16][17]. The Cohen-Woods classification system divides lactic acidosis into types A and B.…”

Section: How Does Metformin Lead To the Development Of Lactic Acidosimentioning

confidence: 99%

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Metformin-Associated Lactic Acidosis (MALA): Case Files of the Einstein Medical Center Medical Toxicology Fellowship

Kopec

Kowalski

2012

J. Med. Toxicol.

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A 39-year-old man presented to the emergency department after intentionally ingesting 50 tablets of metformin 1,000 mg. The reported time of ingestion was 6 h prior to arrival. Vital signs were: temperature, 37.4°C; pulse, 94 beats per minute; blood pressure, 117/74 mmHg; respirations, 16/min; and oxygen saturation, 96 % on room air. Gastric lavage was performed, and a single dose of activated charcoal was given. His initial serum lactate was 4.3 mmol/L (normal00.67-1.8 mmol/L). The patient had a negative urine drug screen, and acetaminophen and salicylate levels were below detection limits. The patient was admitted for monitoring of lactic acidosis.Twenty hours after arrival, the patient became hypotensive with a blood pressure of 85/45 mmHg. Arterial blood gas analysis revealed a pH of 7.20, pCO 2 19 mmHg, and bicarbonate HCO 3 of 6 mmol/L. A repeat serum lactate at this time was 20 mmol/L, and a basic metabolic panel showed sodium of 134 mmol/L, potassium 3.8 mmol/L, chloride 98 mmol/L, bicarbonate 16 mmol/L, BUN 32 mg/ dL, and creatinine 1.3 mg/dL; the calculated anion gap was 20 mmol/L. A 1-L normal saline bolus was administered, and serum alkalinization was initiated with a sodium bicarbonate drip.

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Section: How Does Metformin Lead To the Development Of Lactic Acidosimentioning

confidence: 99%

Section: How Does Metformin Lead To the Development Of Lactic Acidosimentioning

confidence: 99%

Section: How Does Metformin Lead To the Development Of Lactic Acidosimentioning

confidence: 99%

Section: How Does Metformin Lead To the Development Of Lactic Acidosimentioning

confidence: 99%

See 2 more Smart Citations

Metformin-Associated Lactic Acidosis (MALA): Case Files of the Einstein Medical Center Medical Toxicology Fellowship

Kopec

Kowalski

2012

J. Med. Toxicol.

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“…The main excretion site is the kidney; however, the major adverse effects are related with the gastrointestinal system and include abdominal pain, diarrhea and vomiting (1). Lactic acidosis, a serious side effect with a high mortality rate, is a rarely reported complication in patients using this medication (2). Coexistence of some clinical conditions such as dehydration, hypoxemia and the use of nephrotoxic drugs might facilitate the development of lactic acidosis (3).…”

Section: Dıscussıonmentioning

confidence: 99%

Metformin-Associated Lactic Acidosis: A Case Report

İnal¹,

Okyay²,

Armağan³

et al. 2015

Turk Neph Dial Transpl

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A 65-year-old man was admitted to the emergency department with the complaints of general discomfort, nausea, vomiting, abdominal pain, dysuria and shortness of breath. Type II diabetes mellitus, essential hypertension, atrial fibrillation and chronic obstructive pulmonary disease were noted in his medical history. He was using metformin, warfarin and diltiazem besides inhaler medications. Laboratory test results were as follows: BUN 52 mg/dl, creatinine 2.9 mg/dl (one month ago it was 0.9 mg/dl), potassium 6.3 mmol/L, PT-INR 17.78, arterial blood pH 7.05, bicarbonate 5.3 mmol/L, partial carbon dioxide pressure 19 mmHg, and lactate level 175 mg/dl. The urine examination revealed pyuria and urinary density was 1028. The patient was considered to suffer from acute kidney injury, urinary tract infection and metformin-associated lactic acidosis (MALA). Metformin was withdrawn immediately and acute hemodialysis was planned. However, a central venous catheter could not be inserted because of high PT-INR values. Parenteral 0.9% NaCl, glucose -insulin solution infusions, sodium bicarbonate infusion as well as empirical intravenous ceftriaxone treatments were started. He dramatically responded to medical therapy and did not require any dialysis support. In the literature, hemodialysis has been proposed as the initial treatment modality of MALA. However, herein, we presented a favorable outcome without utilizing hemodialysis. key wOrds: Metformin, Metformin-associated lactic acidosis, MALA, Acute kidney injury ÖzAltmış beş yaşında erkek hasta genel durum bozukluğu, bulantı, kusma karın ağrısı, dizüri ve nefes darlığı yakınmaları ile acil servise başvurdu. Öyküsünden, hipertansiyon, tip 2 DM, kronik atriyal fibrilasyon ve KOAH tanıları olduğu; metformin, warfarin, diltiazem ve inhaler tedavileri almakta olduğu öğrenildi. Laboratuvar bulguları BUN: 52 mg/dl, Cr: 2,9 mg/dl (bir ay önce 0,9 mg/dl), K: 6,3 mmol/L, PT-INR: 17,78, arteryal kan gazında pH: 7,05, HCO3: 5,3 mmol/L, pCO2: 19 mmHg, laktat düzeyi: 175 mg/dl idrar dansitesi: 1028, pyüri (+) şeklindeydi. Hastaya akut böbrek yetmezliği, idrar yolu enfeksiyonu ve metformin ilişkili laktik asidoz (MİLA) tanıları konuldu. Metformin derhal kesildi ve acil hemodiyaliz planlandı. Ancak yüksek INR düzeyleri nedeniyle santral venöz kateter takılamadı. Parenteral %0,9 NaCl, nötralize glukoz -insulin solüsyonu, NaHCO3 infüzyonu ve ampirik seftriakson tedavisi başlandı. Hastanın izleminde dramatik düzelme kaydedildi ve diyaliz gereksinimi kalmadı. Literatürde, hemodiyalizin MİLA olgularında öncelikle tedavi yaklaşımı olduğu belirtilmekteyken, bizim olgumuzda hemodiyalize gerek kalmadan oldukça olumlu bir sonuç elde edilmiştir.anahtar sözcükler: Metformin, Metformin ilişkili laktik asidoz, MİLA, Akut böbrek yetersizliği

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Insulin, other hypoglycemic drugs, and glucagon

Page¹

2014

Side Effects of Drugs Annual

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Metformin-associated lactic acidosis treated with prolonged hemodialysis

Cited by 14 publications

References 8 publications

Metformin-Associated Lactic Acidosis (MALA): Case Files of the Einstein Medical Center Medical Toxicology Fellowship

Metformin-Associated Lactic Acidosis (MALA): Case Files of the Einstein Medical Center Medical Toxicology Fellowship

Metformin-Associated Lactic Acidosis: A Case Report

Insulin, other hypoglycemic drugs, and glucagon

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