Lactic acidosis in diabetic patients

1976 ◽  
Vol 136 (9) ◽  
pp. 987-990 ◽  
Author(s):  
M. Fulop
Keyword(s):  
Lactic Acidosis ◽  
Diabetic Patients

Lactic acidosis had developed in diabetic patients receiving herbal therapy

MedPharmRes ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. 22-28
Author(s):  
Uyen Vy Doan ◽  
Thanh Thao T. Nguyen ◽  
Thuy An Nguyen ◽  
Van Hoang Lam ◽  
Duong Tien Truong ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Lactic Acidosis ◽  
Glucose Control ◽  
Blood Glucose Control ◽  
Clinical Findings ◽  
Series Data ◽  
Diabetic Patients ◽  
Herbal Products ◽  
Severe Lactic Acidosis ◽  
Two Samples

Introduction: Herbal antidiabetic products are popular in Vietnam. Many cases have presented to hospitals with severe lactic acidosis, shock and were ultimately fatal. We reviewed the clinical findings of these patients for factors that contributed to their illness and death, and analyzed the ingredients contained in these herbal products sold for diabetic treatment. Method: This was a single-center, retrospective, observational case series. Data were collected on all cases who presented with severe lactic acidosis after use of traditional herbal anti-diabetic pills, over the two-year time period 2018 – 2019. Past medical histories and clinical findings were reviewed. Samples of the herbal anti-diabetic products, and patient blood and urine were analyzed. Results: A total of 18 cases of severe lactic acidosis associated with use of herbal anti-diabetic pills were reviewed. These patients had a diagnosis of diabetes for an average of 9 years (9.4 ± 4.6 years). The use of these herbals for blood glucose control ranged from one month to 8 years; approximately 50% of these patients consumed these products over a year’s time. Only two cases had combined herbal products and metformin 500 mg. A total mean of herbal pills consumed was 9 (SD ± 8); patients commonly took combinations of 2 different colored tablets. Major manifestations included gastrointestinal disorders, severe metabolic acidosis (pH = 6.85 ± 0.22, HCO3- = 4.4 ± 2.6), with multi-organ failure and shock on admission. Hyperlactatemia was present in all cases (195 ± 74 mg/dL). For lactate removal and acidosis correction, intermittent hemodialysis or continuous renal replacement therapy was performed, ranging from 2 hours to 72 hours depending on the severity of lactic acidosis and patient need. The mortality rate was 33.3% and all these patients became hypoglycemic, either at initial presentation or during treatment. 22 samples of herbal pills were available for testing that contained the biguanides metformin and phenformin, with a higher concentration of phenformin than metformin if both were present, Phenformin was presented in all samples. Arsenic was found in two samples. Conclusion: Biguanides are an effective treatment for diabetes and were added to traditional herbal pills sold and used for blood glucose control. Many users of these products are doing so because of the cost and perception of the safety of natural remedies. Biguanide poisoning may still occur even in patients without renal impairment.

Study of metformin in diabetes mellitus with stage 3 and 4 chronic kidney disease

2020 ◽  
Vol 4 (1) ◽  
pp. 21-28
Author(s):  
D. Peeyush ◽  
M. Lamsal ◽  
R. Maskey ◽  
S.K. Sharma
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lactic Acidosis ◽  
Blood Sugar ◽  
Case Reports ◽  
Glycosylated Hemoglobin ◽  
Diabetic Patients ◽  
Insulin Group ◽  
Metformin Group ◽  
Ckd Stage

Background: Chronic Kidney Disease is one of the major complications of Diabetic patients. Cardiovascular mortality increases in patient with diabetes and more so with diabetic CKD. Clinician treating diabetic CKD finds option limited as metformin is considered contraindicated when serum creatinine is greater than 1.5 mg/dl in males and greater than 1.4 mg/dl in females. The primary aim of the study is to evaluate the efficacy of metformin in terms of glycemic control in patient with diabetic stage 3 and 4 CKD. Methods: This is Randomised open labelled clinical trial done in the Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Primary end point were glycemic status at 6 months as defined by with fasting, post prandial blood sugar, glycosylated hemoglobin in comparison to baseline. Results: Altogether 73 diabetic patients with diabetic CKD stage 3 and 4 were included in the study. 41 patients were included in insulin group and 32 patients in metformin group. In metformin group, the fasting and past prandial blood sugar declined progressively compared to insulin group, where fasting and post prandial blood sugar declined more rapidly. Conclusions: Metformin is found to be efficacious in diabetic CKD as it had already proved to be effective in diabetes without CKD. In this study metformin was not associated with lactic acidosis and the level of lactate with metformin treatment was similar to that of treatment with insulin. The vast majority of case reports relating metformin to lactic acidosis report at least one other disease/illness that could result in lactic acidosis. Despite increasing disregard of contraindications to metformin by physicians, the incidence of lactic acidosis has not increased, as does the result of this study. So metformin may be safe even in patients with diabetic CKD stage 3 and 4.  

scholarly journals Does High-Dose Metformin Cause Lactic Acidosis in Type 2 Diabetic Patients after CABG Surgery? A Double Blind Randomized Clinical Trial

2011 ◽  
Vol 6 (1) ◽  
pp. hi.2011.e8 ◽  
Author(s):  
Afshin Gholipour Baradari ◽  
Mohammad Reza Habibi ◽  
Hadi Darvishi Khezri ◽  
Mohsen Aarabi ◽  
Mohammad Khademloo ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Lactic Acidosis ◽  
Randomized Clinical Trial ◽  
Diabetic Patients ◽  
High Dose ◽  
Type 2 Diabetic Patients ◽  
Double Blind ◽  
Cabg Surgery ◽  
Type 2 Diabetic

scholarly journals Continuation or termination of metformin in diabetic patients exposed to iodinated contrast medium?

2019 ◽  
Vol 8 (3) ◽  
pp. 185-189
Author(s):  
Mohamad Ali Dayani
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Lactic Acidosis ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Medical Condition ◽  
Diabetic Patients ◽  
Iodinated Contrast Media ◽  
Iodinated Contrast Medium ◽  
Iodinated Contrast

Lactic acidosis (LA) secondary to metformin administration is a rare incident with a very highmortality rate (≥50%). Hypoxia has been suggested to contribute to metformin-associatedlactic acidosis (MALA) in 90% of patients developing this condition. In susceptible patientssuch as those with renal insufficiency, the level of plasma metformin is increased particularlyafter exposure to iodinated contrast media (ICM). One major concern in patients with renalinsufficiency is to adjust the metformin dose based on the renal functional capacity prior to ICMexamination. In this review, we assessed metformin tolerable threshold in diabetic patients withrenal failure. We also reviewed metformin withdrawal criteria in patients with chronic kidneydisease (CKD) exposed to intravenous ICM during angiography. Our results indicated that inpatients with insufficient renal function (i.e. 30< estimated glomerular filtration rate(eGFR) <60and 30<eGFR<45 mL/min/1.73 m2), or those with acceptable renal function (eGFR ≥60 mL/min/1.73 m2) and concomitant comorbidities, the decision to withhold or reinitiate metforminshould be based on patient’s medical condition.

scholarly journals Hyperlactatemia and the Outcome of Type 2 Diabetic Patients Suffering Acute Myocardial Infarction

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Jovanovic Aleksandar ◽  
Peric Vladan ◽  
Snezana Markovic-Jovanovic ◽  
Radojica Stolic ◽  
Jadranka Mitic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Lactic Acidosis ◽  
Blood Lactate ◽  
Lactate Production ◽  
Diabetic Patients ◽  
Lethal Outcome ◽  
Lactate Levels

Background.Increased lactate production is frequent in unregulated/complicated diabetes mellitus.Methods.Three groups, each consisting of 40 patients (type 2 diabetics with myocardial infarction, DM+AMI, nondiabetics suffering myocardial infarction, MI, and diabetics with no apparent cardiovascular pathology, DM group), were tested for pH, serum bicarbonate and electrolytes, blood lactate, and CK-MB.Results. Blood lactate levels were markedly higher in AMI+DM compared to MI group (4.54±1.44versus3.19±1.005 mmol/L,p<0.05); they correlated with the incidence of heart failure(ρ=0.66), cardiac rhythm disorders(ρ=0.54), oxygen saturation(ρ=0.72), CK-MB levels(ρ=0.62), and poor short-term outcome. Lactic acidosis in DM+AMI group was not always related to lethal outcome.Discussion. The lactate cutoff value associated with grave prognosis depends on the specific disease. While some authors proposed cutoff values ranging from 0.76 to 4 mmol/L, others argued that only occurrence of lactic acidosis may be truly predictive of lethal outcome.Conclusion. Both defective glucose metabolism and low tissue oxygenation may contribute to the lactate production in diabetic patients with acute myocardial infarction; high lactate levels indicate increased risk for poor outcome in this population comparing to nondiabetic patients. The rise in blood lactate concentration in diabetics with AMI was associated with increased incidence of heart failure, severe arrhythmias, cardiogenic shock, and high mortality rate.

Metformin-Associated Nonketotic Metabolic Acidosis

1997 ◽  
Vol 31 (1) ◽  
pp. 53-55 ◽  
Author(s):  
Mark R Jurovich ◽  
John D Wooldridge ◽  
Rex W Force
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Metabolic Acidosis ◽  
Lactic Acidosis ◽  
Early Recognition ◽  
Normal Serum ◽  
Anion Gap ◽  
Diabetic Patients ◽  
Strict Adherence ◽  
Arterial Blood

OBJECTIVE: To document a case of anion gap, nonketotic metabolic acidosis occurring in a patient with acute renal failure who was receiving metformin. CASE SUMMARY: A 67-year-old white man presented with a 9-day history of weakness, nausea, dizziness, and difficulty moving; he had also not eaten during the previous 2 days. The patient had numerous abnormalities on his serum chemistry panel and arterial blood gases, including a pH of 7.1 and an anion gap of 21 mEq/L. No ketones were detected in the urine. The patient was treated with intravenous fluids, sodium bicarbonate, insulin, and hemodialysis. All medications were discontinued. The acidosis resolved shortly after hemodialysis. The hospital course was complicated by the onset of atrial fibrillation occurring on day 2 that did not respond to chemical cardioversion. On day 6 the patient was discharged home with resolving acute renal failure and normal serum pH. CONCLUSIONS: The mortality rate of biguanide-induced lactic acidosis is approximately 50%; thus, early recognition and treatment are essential. Suspicion of lactic acidosis should be high when diabetic patients who are taking a biguanide present with acidosis. The majority of cases of metformin-induced lactic acidosis have occurred in patients with contraindications to the drug (i.e., renal dysfunction). Thus, it is important to maintain strict adherence to these contraindications and monitor patients for deteriorating renal function.

Altered Redox State Obscuring Ketoacidosis in Diabetic Patients with Lactic Acidosis

1970 ◽  
Vol 283 (18) ◽  
pp. 978-980 ◽  
Author(s):  
Errol B. Marliss ◽  
John L. Ohman ◽  
Thomas T. Aoki ◽  
George P. Kozak
Keyword(s):  
Lactic Acidosis ◽  
Redox State ◽  
Diabetic Patients

scholarly journals Acidosis láctica asociada a metformina

2019 ◽  
Vol 11 (5) ◽  
pp. 2
Author(s):  
Maria Fernández Rodríguez ◽  
J Álvarez del Vayo ◽  
A Pascual Casado ◽  
E Zaldibar Enríquez
Keyword(s):  
Lactic Acidosis ◽  
Type Ii Diabetes ◽  
Intestinal Ischemia ◽  
Exploratory Laparotomy ◽  
Diabetic Patients ◽  
Severe Lactic Acidosis ◽  
Drug Of Choice ◽  
Normal Limits ◽  
Oral Antidiabetic ◽  
Elimination Half

La acidosis láctica severa asociada a metformina es una enfermedad grave, poco frecuente, pero con elevada mortalidad que se define en presencia de un pH < 7,35, Lactato > 2 mmol/L y una paCO2  en límites normales.  Presentamos el caso de una paciente en tratamiento con metformina, hipertensa y dislipémica, polimedicada, con acidosis láctica grave ingresada en Reanimación, tras postoperatorio de laparotomía exploradora por sospecha de una isquemia intestinal.  Llega en estado de shock circulatorio, con escasa respuesta a administración de volumen y drogas vasoactivas. Describimos algunos datos sobre su incidencia, la fisiopatología, el pronóstico y el tratamiento, así como la importancia de un diagnóstico precoz y diferencial con otras causas de acidosis metabólicas que eleven el anion GAP.  ABSTRACT Lactic acidosis associated with metformin Metformin is an oral antidiabetic that belongs to the group of the biguainides. It is the drug of choice for the treatment of type II diabetes due to its efficacy and safety. It is a small molecule, whose elimination half-life is 8 to 20 hours in people with normal renal function. Severe lactic acidosis associated with metformin is a serious, infrequent disease (its incidence is estimated between 3-8 cases per 100,000 diabetic patients and year) but with high mortality (around 40% in accidental poisonings), which is defined in presence of a pH <7.35, lactate> 2 mmol / L and a paCO2 in normal limits. We present the case of a diabetic patient under treatment with metformin, hypertense and dyslipidemic, polymedicated, with severe lactic acidosis, in a Reanimation Care unit, after postoperative exploratory laparotomy due to suspicion of intestinal ischemia. He arrives in a state of circulatory shock, with little response to the administration of volume and vasoactive drugs. We describe some data about its incidence, pathophysiology, prognosis and treatment, as well as the importance of an early and differential diagnosis with other causes of metabolic acidosis that elevate the GAP anion.

scholarly journals Lactic acidosis associated with metformin in diabetic patients with chronic kidney disease: a multicentre case-control study using electronic health records

2020 ◽  
Author(s):  
Mónica Ávila ◽  
Sebastian Videla ◽  
Ainhoa Gómez-Lumbreras ◽  
Marcela Manriquez ◽  
Oriol Prat ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lactic Acidosis ◽  
Primary Healthcare ◽  
Diabetic Patients ◽  
Health Records ◽  
Increased Risk ◽  
Diuretic Drugs ◽  
Control Study

Abstract Background Several studies have assessed the risk of lactic acidosis with metformin use. However, data of this association in patients with renal impairment are still scarce and controversial. Our aim was therefore to assess the association between metformin and lactic acidosis in Spanish type 2 diabetic patients with chronic kidney disease. Methods A case-control study (ALIMAR-C2) was performed using the electronic health records from hospitals linked to their corresponding primary healthcare regions. The cases were adult (≥ 18 years) diabetic patients with chronic kidney disease, admitted to seven Spanish hospitals from 2010 to 2016. Ten controls (≥ 18 years, diabetic patients with chronic kidney disease) per case were selected from the population within the same primary healthcare region of the hospital cases. The patients’ hospital health records were linked to their corresponding primary healthcare information. Analyses included multivariable logistic regression and adjustment for potential confounders. Results Our study included 126 cases and 1,260 matched controls. The current use of metformin and administration at high doses (> 2 g) were associated with lactic acidosis (adjusted OR: 1.92, 95% CI: 1.21–3.03; OR: 3.13, 95% CI: 1.63–6.01, respectively). The estimated case fatality rate was 46.8% (95% CI: 38.3–55.5%). An increased risk of lactic acidosis was observed in patients with mild to moderate renal impairment (OR: 3.41, 95% CI: 1.48–7.85). As an unexpected finding, diuretic drugs use was also associated with lactic acidosis (OR: 2.73, 95% CI: 1.67–4.46). Conclusions Metformin was associated with an increased risk of lactic acidosis in patients with type 2 diabetes mellitus and chronic kidney disease. New data is needed to confirm the association between diuretic drugs and lactic acidosis in this group of patients.

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