Lactat-Azidose ? Eine m�gliche Komplikation der Buformin-Therapie

Abstract

Lactic acidosis is defined as a state of metabolic acidosis (arterial pH below 7.36) due to an increase in the blood concentration of lactate above 2 mEq/l. Lactic acidosis may occur under a variety of conditions; the biguanide-induced lactic acidosis is due to the toxic effects of biguanides (buformin, metformin, phenformin). The clinical picture is characterized by the occurrence of disturbances of consciousness, severe acidosis with Kussmaul's respiration, shock, hypothermia and in about 30% of all cases hypoglycemia. Apart from the general principles of intensive medical care, therapy should comprise correction of the acid-base-disturbances and elimination of the offending biguanide. The efficacy of hemodialysis in the treatment of biguanide-induced lactic acidosis is difficult to evaluate. By a more sensible use of biguanides, lactic acidosis secondary to drug administration should become a rare event.

Buformin concentrations in a case of fatal lactic acidosis

“…The ability of biguanides to lower blood glucose concentration is explained by several mechanisms [2,6,10,11]. The effects of biguanides on lactic acid production have been reviewed [4,6].…”

“…Plasma half-life is about 2 h. Buforrain is almost completely excreted by the kidneys as the unchanged drug by both glomerular filtration and tubular secretion. Renal clearance is about 450 roll min [1,11,13]. After oral as well as IV administration of labelled buformin in human diabetics with normal renal function the buformin concentrations in theintestinal, mucosa and the liver were many times.…”

“…In patients with lactic acidosis during buformin therapy plasma concentrations up to 3.0 mg/l have been measured [2,3,11]. No data are available on buformin concentrations in other body fluids and tissues during lactic acidosis.…”

Buformin concentrations in a case of fatal lactic acidosis

“…The ability of biguanides to lower blood glucose concentration is explained by several mechanisms [2,6,10,11]. The effects of biguanides on lactic acid production have been reviewed [4,6].…”