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Year : 2014  |  Volume : 5  |  Issue : 2  |  Page : 2

Metformin-associated lactic acidosis: a hospital experience

1 Nephrology 2nd year resident, Centro Hospitalar de Coimbra
2 Internal Medicine 4th year resident, Centro Hospitalar de Coimbra
3 Internal Medicine 5th year resident, Centro Hospitalar de Coimbra
4 Nephrologist, department of Nephrology, Centro Hospitalar de Coimbra
5 Graduate Assistant, department of Internal Medicine, Centro Hospitalar de Coimbra
6 Graduate Assistant, department of Nephrology, Centro Hospitalar de Coimbra
7 Chief of Internal Medicine department, Centro Hospitalar de Coimbra

Correspondence Address:
M G Marques
Nephrology 2nd year resident, Centro Hospitalar de Coimbra

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Source of Support: None, Conflict of Interest: None

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Metformin-associated lactic acidosis (MLA) is a rare but fatal complication. Data reveal that the incidence of MLA is less than 5.1 cases per 100,000 patient years with the mortality rate of 30-50%. The aim of the study was to determine the incidence of MLA in patients with diabetes admitted in our hospital and to identify the predisposing medical conditions, prognostic factors and outcome of these patients. We also compared our results with previously published data to identify specific features of MLA and formulate recommendations regarding our population. Retrospective analysis of all cases of lactic acidosis admitted in our hospital between 2006 and 2010 was done. Lactic acidosis (LA) was defined by serum pH < 7.35 and serum lactate ≥ 4 mmol/l. Eleven cases of MLA (4.35% of the total cases of acidosis) were observed. The average age was 71.0 ΁ 12.9 years. Mean dosage was 2000 mg/day. The cause was identified as an acute gastrointestinal event with dehydration and hypovolemia in 54.55% and decompensated heart failure was the second most frequent cause (18.18%); one patient had decompensated chronic obstructive pulmonary disease (COPD) with respiratory failure, one had a urinary tract infection and one patient had chronic kidney disease (CKD) stage 4/5. Average serum creatinine on admission was 456.65 μmol/l. Seven patients needed hemodialysis, one did not regain renal function and one patient died. The incidence of MLA is increasing due to increased Metformin prescription in the increasing population of patients with type 2 diabetes and associated co-morbidities. It is important to be aware of this complication, identify people at risk and manage the drug dosage or withhold it according to renal function and other co-morbidities. Because this complication is often precipitated by an acute event or decompensation of a chronic condition, it is essential to inform patients to stop their treatment in such situations.

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