Reviews show a stable prevalence of this phenomenon, but nephrological experience is required since it is frequently involved in therapeutic management. Risk factors include renal insufficiency, higher doses of metformin, and alcoholism. Acidose metabolica disturbios endocrinos e metabolicos. The incidence of lactic acidosis with metformin is estimated to be 20 times less than with phenformin. Madias abstract metabolic acidosis is characterized by a primary reduction in serum bicarbonate hco 3 concentration, a secondary decrease in the arterial partial pressure of carbon dioxide paco 2 of 1 mmhg for every 1 mmoll fall in. Association of metformin use with risk of lactic acidosis. Evaluate incidence of metformin associated lactic acidosis, admission in intensive care unit icu or medicalsurgical unit, severity of metabolic acidosis and mortality. We discuss the pathophysiological mechanisms of lactic acidosis with particular regard to the role played by the drug as a potential cause of the entity. Acidosi metabolica malattie endocrine e metaboliche. Metforminsglt2, dehydration, and acidosis potential. However, the information available in patients with moderatesevere chronic kidney disease is scarce. Risk factors include renal insuciency, higher doses of metformin, and alcoholism. Metformin amplifies the degree of lactic acidosis, but its not the sole cause of the illness. Acidosis lactica por metformina endocrinologia y nutricion.
Metformin is the only oral hypoglycaemic agent proved to reduce cardiovascular risk and is now recognised as the treatment of choice in overweight patients with type 2 diabetes. Acidosis metabolica, tratamiento, hipercloremia y acidosis metabolica abstract metabolic acidosis is defined as an arterial blood ph metformina raul carrillo esper, jesus ojino sosa garcia resumen antecedentes. It is a form of metabolic acidosis, in which excessive. Rates of metformin associated lactic acidosis is about nine per 100,000 personyears, which is similar to the background rate of lactic acidosis in the general population. Cortese silvia, di nardo victoria, neira alejandra, mathius helena y portela mariana. Metabolic acidosis is defined as an arterial blood ph acidosis. Treatment of metformin intoxication complicated by lactic acidosis. Metformin associated lactic acidosis is a severe and infrequent adverse event. Caso clinico felipe quintana1, maria jose pezzani 1, rodrigo orozco2, jorge dreyse3, leonardo soto3, tomas regueira 3 metformin associated lactic acidosis. Metformin associated lactic acidosis is related with the used dose and underlying conditions that may lead to high serum lactate. Dehydration in patients taking metformin can lead to metformin associated lactic acidosis, a potentially fatal condition metformin, a dimethylbiguanide, is a widely used oral antihyperglycaemic drug used in the long term treatment of type 2 diabetes mellitus. The patient was admitted to the intensive care unit for refractory shock, acute respiratory failure, oliguric acute kidney injury, severe ag metabolic acidosis, and. Preclinical studies also indicate that increased plasma lactate concentrations and lactic acidosis are related to biguanide dose and plasma levels, with phenformin being the most potent, followed by buformin, and metformin. Trastornos del metabolismo acidobase nefrologia al dia.
Effect of metformin on glucose metabolism in the splanchnic bed. Ba sed on this classification, it may establish the most appropriate treatment. Metformin, along with other drugs in the biguanide class, increases plasma lactate levels in a plasma concentrationdependent manner by inhibiting mitochondrial respiration. Background metformin therapy for type 2 diabetes mellitus has been shown to reduce total mortality rates compared with other antihyperglycemic treatments but is thought to increase the risk of lactic acidosis. Lower egfr was a risk factor for acidosis in both metformin and sulfonylurea users. The use of metformin in patients with type 2 diabetes mellitus has been associated with lactic acidosis.
We present a case of metformin associated lactic acidosis mala where drug interactions orlistat in the long term and cimetidine over a short period of time may have potentiated. There were 238 acidosis events among metformin users, and 94 among sulfonylurea users. Metformina y diabetes mellitus tipo 2 sciencedirect. Report of one case metforminassociated lactic acidosis is a severe and infrequent adverse event. Early diagnosis is essential to start an early treatment, which often has favorable results. Report of one case metformin associated lactic acidosis is a severe and infrequent adverse event. Risk of fatal and nonfatal lactic acidosis with metformin. Metabolic acidosis expected and fatal adverse effects of metformin. Metformin induced lactic acidosis is a rare complication, with a reported prevalence of 15 cases x 100 000 patients and a mortality rate of 30 to 50%, and is commonly associated with an underlying condition that makes the direct correlation and the final diagnosis hard to stablish. Pdf lactic acidosis induced by metformin incidence. Lactic acidosis is a serious but uncommon side effect of metformin use. Metformin is an oral antidiabetic agent and is recommended as first line treatment in type 2 diabetes mellitus. Clinically it will be impossible to differentiate this from mala. If the anion gap is normal, and all of the change has occurred in the chloride bicarbonate proportions, then the numerator will be low and the denominator will be high so a normal anion gap acidosis.
Explain to patient that metformin helps control hyperglycemia but does not cure diabetes. This may happen due to gastrointestinal loss from metformin diarrhea or urine loss from diuretics. More recently it has also been used to improve fertility and weight reduction in patients with polycystic ovary syndrome. Methods a comprehensive search was performed to identify all comparative trials or.
The true incidence of fatal and nonfatal lactic acidosis associated with metformin use is not known. Renal dialysis to remove metformin and correct metabolic acidosis has been recommended to treat mala 34, 35, 48, 49, arguing in favor of a relationship. Lactic acidosis is an uncommon side effect of metformin use, which is more likely to arise in patients with certain predisposing factors. Metformin amplies the degree of lactic acidosis, but its not the sole cause of the illness. Although metformin has become a drug of choice for the treatment of type 2 diabetes mellitus, some patients may not receive it owing to the risk of lactic acidosis. Acidosis lactica por metformina desencadenada por una. Metformininduced lactic acidosis with emphasis on the anion gap. Renal dialysis to remove metformin and correct metabolic. Caso clinico felipe quintana1, maria jose pezzani 1, rodrigo orozco2, jorge dreyse3, leonardo soto3, tomas regueira 3 metforminassociated lactic acidosis. Review of diabetes medicines called sglt2 inhibitors started. In the majority of reported cases there is a preexisting disease, most often a degree of renal impairment.
The recent addition of a group of agents to control diabetes through increased glycosuria may increase the risk of dehydration and acidosis. We present the case of a patient with hypertension treated with indapamide and captopril and type 2 diabetes mellitus treated with insulin and metformin. Guidelines for the management of metabolic acidosis by dr. Pdf metformin is an oral antidiabetic drug that is widely used alone or in combination. Lactic acidosis associated with metformin has low prevalence and mortality of 30 to 50%. In geriatric populations lactic acidosis due to diminishing kidney function is an issue. Lactic acidosis associated with metformin in patients with.