Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus

Salpeter, Shelley R.; Greyber, Elizabeth; Pasternak, Gary A; Salpeter, E. E.

doi:10.1002/14651858.cd002967.pub3

Cited by 297 publications

(177 citation statements)

References 389 publications

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“…Th e most common side eff ects of metformin use are gastrointestinal, including diarrhea, nausea, vomiting, abdominal bloating, and anorexia. Th ese side eff ects may occur in 20% to 30% of patients receiving this drug, usually at the onset of therapy, but rarely persist (9). Current contraindications for metformin use include chronic kidney disease (creatinine levels >1.5 mg/dL in men and >1.4 mg/dL in women), liver disease, heart failure, age >65, pulmonary disease, use of intravenous contrast agents within 48 hours, or any condition with relative tissue hypoxia (9).…”

Section: Discussionmentioning

confidence: 99%

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Metformin-Induced Lactic Acidosis with Emphasis on the Anion Gap

Blough¹,

Moreland²,

Mora³

2015

Baylor University Medical Center Proceedings

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Section: Discussionmentioning

confidence: 99%

“…Lactic acidosis is a rare but serious side eff ect of metformin use. Th e estimated incidence is 6 cases per 100,000 patient-years (9). Th e presence of metformin-associated hyperlactatemia in critical care patients has been associated with a mortality >30% (10).…”

Section: Discussionmentioning

confidence: 99%

Metformin-Induced Lactic Acidosis with Emphasis on the Anion Gap

Blough¹,

Moreland²,

Mora³

2015

Baylor University Medical Center Proceedings

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“…Recently, a Cochrane Review demonstrated a low incidence for MALA in adult patients with type 2 diabetes receiving metformin in the context of clinical studies. Poisson statistics reported 5.1 cases per 100,000 patient-years [59,60]. There is some evidence that high doses of metformin lead to MALA, especially in patients with impaired kidney function [61,62].…”

Section: Pathophysiologymentioning

confidence: 99%

Drug-induced acid-base disorders

et al. 2014

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The incidence of acid-base disorders (ABDs) is high, especially in hospitalized patients. ABDs are often indicators for severe systemic disorders. In everyday clinical practice, analysis of ABDs must be performed in a standardized manner. Highly sensitive diagnostic tools to distinguish the various ABDs include the anion gap and the serum osmolar gap. Drug-induced ABDs can be classified into five different categories in terms of their pathophysiology: (1) metabolic acidosis caused by acid overload, which may occur through accumulation of acids by endogenous (e.g., lactic acidosis by biguanides, propofol-related syndrome) or exogenous (e.g., glycol-dependant drugs, such as diazepam or salicylates) mechanisms or by decreased renal acid excretion (e.g., distal renal tubular acidosis by amphotericin B, nonsteroidal antiinflammatory drugs, vitamin D); (2) base loss: proximal renal tubular acidosis by drugs (e.g., ifosfamide, aminoglycosides, carbonic anhydrase inhibitors, antiretrovirals, oxaliplatin or cisplatin) in the context of Fanconi syndrome; (3) alkalosis resulting from acid and/or chloride loss by renal (e.g., diuretics, penicillins, aminoglycosides) or extrarenal (e.g., laxative drugs) mechanisms; (4) exogenous bicarbonate loads: milk-alkali syndrome, overshoot alkalosis after bicarbonate therapy or citrate administration; and (5) respiratory acidosis or alkalosis resulting from drug-induced depression of the respiratory center or neuromuscular impairment (e.g

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“…The incidence of metformin-associated lactic acidosis is not well known. Salpeter et al (12) reported that the incidence of lactic acidosis associated with the use of metformin is 8.1 cases per 100,000 patient-years, although the mortality rate of metformin-associated lactic acidosis is approximately 50% (13). Metformin induces the production of lactic acid by interfering with glucose oxidase in the muscles and intestines (14).…”

Section: Discussionmentioning

confidence: 99%

Severe Lactic Acidosis and Acute Pancreatitis Associated with Cimetidine in a Patient with Type 2 Diabetes Mellitus Taking Metformin

et al. 2013

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An 82-year-old woman with type 2 diabetes mellitus, hypertension, and unstable angina presented with severe lactic acidosis and acute kidney injury (AKI) accompanied by acute pancreatitis. Her medical history revealed that she had taken cimetidine for two weeks while taking other medications, including metformin. Continuous veno-venous hemodiafiltration (CVVHDF) was initiated under diagnosis of lactic acidosis due to metformin and AKI caused by cimetidine-induced acute pancreatitis. In three days of CVVHDF, the levels of serum biochemical markers of lactic acidosis and AKI improved and the patient's urine output reached over 1 L/day. The pancreatitis improved over time.

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Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus

Cited by 297 publications

References 389 publications

Metformin-Induced Lactic Acidosis with Emphasis on the Anion Gap

Metformin-Induced Lactic Acidosis with Emphasis on the Anion Gap

Drug-induced acid-base disorders

Severe Lactic Acidosis and Acute Pancreatitis Associated with Cimetidine in a Patient with Type 2 Diabetes Mellitus Taking Metformin

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