scholarly journals Metformin-Induced Lactic Acidosis: A Question of Time

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Céline Bellefroid ◽  
Pierre Goffin ◽  
Julien Guntz ◽  
Marine Deville
Keyword(s):  
Lactic Acidosis ◽  
Type Ii Diabetes ◽  
High Flow ◽  
Type Ii ◽  
Severe Lactic Acidosis ◽  
Oral Antidiabetic ◽  
Metformin Concentration ◽  
Life Threatening

Metformin is an oral antidiabetic largely prescribed in the treatment of type II diabetes. Overdose is associated with life-threatening lactic acidosis. We report the case of the highest metformin concentration ever described secondary to a voluntary suicidal intake. The patient developed a severe lactic acidosis and hemodynamic shock successfully treated with high-flow hemofiltration. Time to start extrarenal epuration is capital to avoid poor evolution.

Dialysis therapy for lactic acidosis caused by metformin intoxication: presentation of two cases

2011 ◽  
Vol 30 (12) ◽  
pp. 1995-1997 ◽  
Author(s):  
Yasemin Usul Soyoral ◽  
Huseyin Begenik ◽  
Habib Emre ◽  
Enver Aytemiz ◽  
Mustafa Ozturk ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Side Effects ◽  
Lactic Acidosis ◽  
Type Ii Diabetes ◽  
Type Ii Diabetes Mellitus ◽  
High Dose ◽  
Type Ii ◽  
Dialysis Therapy ◽  
Oral Antidiabetic ◽  
High Doses

Metformin is an oral antidiabetic, which is frequently used in the treatment of type II diabetes mellitus. Serious side effects may be seen during the administration of high doses of metformin. Two cases of lactic acidosis due to ingestion of high dose metformin for suicidal purposes have been presented here; in both cases, clinical improvement was seen with bicarbonate hemodialysis.

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.

Proposal for the administration of metformin in patients with chronic kidney disease

2012 ◽  
Vol 153 (39) ◽  
pp. 1527-1535 ◽  
Author(s):  
Zoltán Balogh ◽  
János Mátyus
Keyword(s):  
Lactic Acidosis ◽  
Chronic Renal Disease ◽  
Antidiabetic Agent ◽  
First Line ◽  
Oral Antidiabetic Agent ◽  
Oral Antidiabetic ◽  
Cardiovascular Morbidity And Mortality ◽  
Glomerular Filtrate ◽  
Life Threatening

Metformin is the first-line, widely used oral antidiabetic agent for the management of type 2 diabetes. There is increasing evidence that metformin use results in a reduction in cardiovascular morbidity and mortality, and might have anticancer activity. An extremely rare, but potentially life-threatening adverse effect of metformin is lactic acidosis, therefore, its use is traditionally contraindicated if the glomerular filtrate rate is below 60 mL/min. However, lactic acidosis is always associated with acute events, such as hypovolemia, acute cardiorespiratory illness, severe sepsis and acute renal or hepatic failure. Furthermore, administration of insulins and conventional antihyperglycemic agents increases the risk of severe hypoglycemic events when renal function is reduced. Therefore, the magnitude of the benefit of metformin use would outweigh potential risk of lactic acidosis in moderate chronic renal disease. After reviewing the literature, the authors give a proposal for the administration of metformin, according to the calculated glomerular filtrate rate. Orv.Hetil., 2012, 153, 1527–1535.

Metformin-Associated Lactic Acidosis in Chinese Patients with Type II Diabetes

Pharmacology ◽  
2011 ◽  
Vol 88 (5-6) ◽  
pp. 260-265 ◽  
Author(s):  
Chun Wing Yeung ◽  
Ho Yin Chung ◽  
Bonnie Mei Wah Fong ◽  
Nga Wing Tsai ◽  
Wai Ming Chan ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Type Ii Diabetes ◽  
Chinese Patients ◽  
Type Ii

scholarly journals A Survey on Oral Antidiabetic Drugs available in Market for Non-complicated Diabetic Patients within Ratnagiri Region

2020 ◽  
Vol 13 (4) ◽  
pp. 399-409
Author(s):  
M. Y Agrawal ◽  
Y. P Agrawal ◽  
A Pedhavi ◽  
G Hanmante ◽  
K. Sharma
Keyword(s):  
Type Ii Diabetes ◽  
Type Ii Diabetes Mellitus ◽  
Antidiabetic Drugs ◽  
Fixed Dose ◽  
Diabetic Patients ◽  
Pharmaceutical Companies ◽  
Type Ii ◽  
Oral Antidiabetic Drugs ◽  
Present Survey ◽  
Oral Antidiabetic

Background: This survey was designed to analyze the current oral anti-diabetic drugs prescribed for non-complicated diabetic patients within Ratnagiri region on the basis of variation in prices of same drug available in different brands. Methods: The present survey has been conducted for a period of 4 months involving number of medical stores in Ratnagiri, Maharashtra, Doctors and Patients with randomly evaluating around 650 prescriptions. A standard questionnaire was prepared containing different questions; based on patient’s data (such as age, gender, disease history and medications), Doctor’s data (commonly prescribed drug, combination) and chemist data (available alternatives, cost and most selling brands). Results: Statistical analysis of patients data revels that there were 47.5% patients are in between the ages of 50 to 60 years and 92.5 % patient depends on oral antidiabetic drugs. Hypertension was the most common complication found among them (54%). Data from Doctor’s during survey suggested Metformin as mostly prescribed drug to patients having type- II Diabetes Mellitus as a single entity or in fixed dose combinations with Glimiperide or Gliclazide. An exhaustive survey over medical shops revealed that many brands of Metformin and Metformin in combination with Glimiperide or Gliclazide are available in market, but Glycomate (Metformin), Glycomate GP-1 (Metformin and Glimiperide) and Glizid-M (Metformin and Gliclazide) is mostly prescribed by Doctors and sold by Chemist though their cheapest alternatives are available in market. Cost analysis indicates that, wide variation in price of several brands (75-87 %) for oral anti-diabetics. Annual Turnover of these products in Indian domestic market indicates dominance of USV Pvt. Ltd. and Mankind Ltd. over other Pharmaceutical companies. Conclusions: This report will create better awareness among people for the availability of various brands of same anti-diabetic drug and also motivate our physicians to prescribe the economic products.

Impact of Japanese regulatory action on metformin-associated lactic acidosis in type II diabetes patients

2015 ◽  
Vol 37 (3) ◽  
pp. 537-545 ◽  
Author(s):  
Tadaaki Hanatani ◽  
Kimie Sai ◽  
Masahiro Tohkin ◽  
Katsunori Segawa ◽  
Yoshiro Saito
Keyword(s):  
Lactic Acidosis ◽  
Type Ii Diabetes ◽  
Regulatory Action ◽  
Type Ii ◽  
Diabetes Patients

scholarly journals Reversible Total Vision Loss Caused by Severe Metformin-associated Lactic Acidosis: A Case Report

2021 ◽  
Vol 2 (5) ◽  
pp. 206-209
Author(s):  
Andrew Koons ◽  
Alexandra Amaducci ◽  
Kenneth Katz
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Case Report ◽  
Lactic Acidosis ◽  
Visual Loss ◽  
Vision Loss ◽  
Hospital Emergency Department ◽  
Type Ii ◽  
Hospital Emergency ◽  
Metformin Concentration

Introduction: Metformin is a biguanide used to treat diabetes mellitus (DM). Metformin-associated lactic acidosis (MALA) carries a high mortality and can occur in patients with renal failure from drug bioaccumulation. Reversible vision loss is a highly unusual, rarely reported complication of MALA. We present a case of a patient whose serum metformin concentration was unusually high and associated with vision loss. Case Report: A 60-year-old woman presented to an outside hospital emergency department with acute vision loss after being found at home confused, somnolent, and hypoglycemic, having last being seen normal two days prior. She reported vomiting and diarrhea during that time and a recently treated urinary tract infection. The visual loss resolved with continuous renal replacement therapy. Conclusion: This novel case of a patient with Type II DM prescribed metformin and insulin who developed reversible vision loss while suffering from MALA highlights the potential for vision loss in association with MALA.

scholarly journals A STUDY OF THE POSSIBLE DRUG-DRUG INTERACTIONS INVOLVING ORAL ANTIDIABETIC DRUGS IN PATIENTS WITH TYPE II DIABETES

2019 ◽  
Vol 10 (5) ◽  
pp. 141-144
Author(s):  
Sapna K Dongre ◽  
Anju Paulose ◽  
Nagesh G N ◽  
Amrutha Jacob ◽  
Suhag As-Hal ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Type Ii Diabetes ◽  
Antidiabetic Drugs ◽  
Type Ii ◽  
Oral Antidiabetic Drugs ◽  
Oral Antidiabetic

scholarly journals Early Initiation of Hemodialysis for Progressive Lactic Acidosis in a Diabetic Patient

2018 ◽  
Vol 1 (1-3) ◽  
pp. 17-20
Author(s):  
Keisuke Nyunoya ◽  
Naoki Hayase ◽  
Kent Doi ◽  
Toshifumi Asada ◽  
Yoshihiro Ueda ◽  
...  
Keyword(s):  
Intensive Care ◽  
Lactic Acidosis ◽  
Altered Mental Status ◽  
Early Initiation ◽  
Critical Conditions ◽  
Diabetic Patients ◽  
Severe Lactic Acidosis ◽  
Metformin Concentration ◽  
History Of ◽  
Lactate Levels

Metformin, a widely used medicine for diabetes mellitus, is well known to cause lactic acidosis, which may require intensive care, including hemodialysis, especially in severe cases because of the high mortality rate. Because metformin is effectively removed by renal replacement therapy, early initiation of hemodialysis is crucial for metformin overdose. We report a case of a 38-year-old male who was brought to our emergency department (ED) with altered mental status. He subsequently developed severe lactic acidosis with a peak lactate level of 33.4 mmol/L. No clear etiology was identified for these critical conditions at the ED. Although metformin intoxication could not be confirmed at this time, we decided to start hemodialysis immediately. Soon after hemodialysis, blood pH and lactate levels dramatically improved. The patient fully recovered after 9 days of intensive care unit (ICU) stay. Later on, his serum metformin concentration was revealed to be 146 μg/mL and 26 μg/mL at ICU admission and after dialysis at day 3, respectively (therapeutic range, 1–2 μg/mL). Early initiation of hemodialysis might be beneficial for diabetic patients with unexplained severe lactic acidosis despite uncertainties in history of overdose or serum concentration of metformin.

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