Metformin‐associated lactic acidosis: <scp>M</scp>oving towards a new paradigm?

Bicsak, Thomas A.; Walsh, B. Timothy; Fineman, Mark

doi:10.1111/dom.12994

Cited by 13 publications

(7 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2) MALA: Cases where additional other conditions that will cause LA with metformin use. 3) Metformin-unrelated LA: Cases in which LA develops due to other conditions rather than metformin accumulation [7]. Our patient used high-dose metformin, and there were no abnormalities in the initial hemogram, biochemistry, and coagulation parameters.…”

Section: Discussionmentioning

confidence: 81%

A Rare Case of Mortal Metformin Intoxication

Az¹,

Akdemir²

2022

globecc

View full text Add to dashboard Cite

Metformin is the first-line oral antidiabetic for treating type 2 diabetes mellitus (DM). Its major toxicity is lactic acidosis (LA). Metformin-induced LA (MILA) rarely develops in the absence of an acute overdose. However, LA is the most serious complication of metformin intoxication, and MILA is associated with high mortality rates. We presented a comparative evaluation of a mortal MILA case with the literature. A 47-year-old woman with type 2 DM and using metformin, admitted to the emergency department with abdominal pain and vomiting that started 4 h after taking 60 gr metformin for suicide. There was no abnormality on her initial hemogram, biochemical profile, or coagulation findings. However, her arterial blood gas analysis on admission was remarkable for pH: 7.025 and lactate: 20.32 mmol/L. HD was planned rapidly in the patient with high anion gap metabolic acidosis. Despite the aggressive therapy, the patient developed ventricular fibrillation and then cardiac arrest and died in the 4 th hour of her admission to the emergency department. Under acute and high-dose metformin intoxication, metabolic acidosis can develop rapidly. Hemodialysis therapy should not be delayed, particularly in cases with MILA. It should be remembered that these cases are mortal despite aggressive treatment.

show abstract

Section: Discussionmentioning

confidence: 81%

A Rare Case of Mortal Metformin Intoxication

Az¹,

Akdemir²

2022

globecc

View full text Add to dashboard Cite

show abstract

“…Lactic acidosis is an acutely life‐threatening event, and it is clearly important to minimize its occurrence. The risk of lactic acidosis when metformin is prescribed appropriately is low, and patients with “metformin associated lactic acidosis” often have limited documentation of the circulating level of metformin, or have additional risk factors for lactic acidosis . The studies described above suggested that treatment with metformin is effective and safe, with appropriate dose adjustment, for people with CKD.…”

Section: Metformin In Chronic Kidney Diseasementioning

confidence: 99%

Metformin and cardiorenal outcomes in diabetes: A reappraisal

Petrie

Rossing

Campbell

2020

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

The guidance issued to the pharmaceutical industry by the US Food and Drug Administration in 2008 has led to the publication of a series of randomized, controlled cardiovascular outcomes trials with newer therapeutic classes of glucose-lowering medications. Several of these trials, which evaluated the newer therapeutic classes of sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, have reported a reduced incidence of major adverse cardiovascular and/or renal outcomes, usually relative to placebo and standard of care. Metformin was the first glucose-lowering agent reported to improve cardiovascular outcomes in the UK Prospective Diabetes Study (UKPDS) and thus became the foundation of standard care. However, as this clinical trial reported more than 20 years ago, differences from current standards of trial design and evaluation complicate comparison of the cardiovascular profiles of older and newer agents. Our article revisits the evidence for cardiovascular protection with metformin and reviews its effects on the kidney. K E Y W O R D Satherosclerotic cardiovascular disease, cardiovascular outcomes, chronic kidney disease, glucose-lowering therapy, metformin

show abstract

“…Numerous studies have explored whether the relationship between biguanides and LA is causal, associated, or coincidental. The incidence rate of metformin-associated LA reportedly ranges from 0 to 138 cases per 100,000 person-years [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. A study indicated that the incidence rate of LA was higher in a diabetic group than in a non-diabetic group, but the rate was not significantly higher in patients taking metformin [ 18 ], suggesting that the risk is increased by the presence of diabetes.…”

Section: Introductionmentioning

confidence: 99%

“…A study indicated that the incidence rate of LA was higher in a diabetic group than in a non-diabetic group, but the rate was not significantly higher in patients taking metformin [ 18 ], suggesting that the risk is increased by the presence of diabetes. As the relationship between the degree of metformin accumulation and the severity of a secondary hypoxic condition, which relates to LA risk, is clinically complex [ 15 ], liver and kidney functions related to metformin metabolism and cardiovascular problems, such as a heart failure caused by secondary hypoxia, can be potential confounders associated with the risk of developing LA. However, the results of pharmacophysiological and pharmacopathological analyses of metformin have suggested that LA is rarely induced if the liver and kidneys are able to metabolize lactate [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Risk of Lactic Acidosis in Hospitalized Diabetic Patients Prescribed Biguanides in Japan: A Retrospective Total-Population Cohort Study

Mohri

Okamoto

Nishioka

et al. 2023

IJERPH

View full text Add to dashboard Cite

Patient data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) are used to assess the effect of biguanide administration on rates of lactic acidosis (LA) in hospitalized diabetes mellitus (DM) patients. In this retrospective cohort study (from April 2013 to March 2016), we compare DM inpatients prescribed biguanides to DM inpatients who were not prescribed biguanides to quantify the association between biguanides and incidence of LA. In total, 8,111,848 DM patient records are retrieved from the NDB. Of the 528,768 inpatients prescribed biguanides, 782 develop LA. Of the 1,967,982 inpatients not prescribed biguanides, 1310 develop LA. The rate ratio of inpatients who develop LA and are administered biguanides to those who developed LA without receiving biguanides is 1.44 (95% CI, 1.32–1.58). Incidence rates and rate ratios for both sexes are elevated in the group prescribed biguanides for patients aged 70 years and older, markedly in those 80 years and older: 40.12 and 6.31 (95% CI, 4.75–8.39), respectively, for men and 34.96 and 5.40 (95% CI, 3.91–7.46), respectively, for women. Biguanides should be used conservatively in patients older than 70 years, particularly for those with comorbidities, and with caution in patients 80 years and older.

show abstract

Metformin‐associated lactic acidosis: Moving towards a new paradigm?

Cited by 13 publications

References 15 publications

A Rare Case of Mortal Metformin Intoxication

A Rare Case of Mortal Metformin Intoxication

Metformin and cardiorenal outcomes in diabetes: A reappraisal

Risk of Lactic Acidosis in Hospitalized Diabetic Patients Prescribed Biguanides in Japan: A Retrospective Total-Population Cohort Study

Contact Info

Product

Resources

About