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[Metformin associates lactic acidosis].

Florent Montini1, Eric Rondeau, Julie Peltier

  • 1Assistance publique-Hôpitaux de Paris, hôpital Tenon, urgences néphrologiques et transplantation rénale, 75020 Paris, France. flomontini@yahoo.fr

Presse Medicale (Paris, France : 1983)
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Metformin-Associated Lactic Acidosis (MALA) is a rare but fatal condition. It often occurs with inappropriate metformin use, especially in elderly or hypovolemic patients, requiring prompt intervention.

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Area of Science:

  • Nephrology
  • Endocrinology
  • Critical Care Medicine

Background:

  • Metformin is a common treatment for type 2 diabetes.
  • Metformin-Associated Lactic Acidosis (MALA) is a rare complication.
  • MALA carries a high mortality rate (30-50%).

Observation:

  • MALA presents as metabolic acidosis with high anion gap and elevated blood lactate.
  • Clinical presentation can be deceptively mild despite severe hyperlactatemia.
  • Triggers are common, with hypovolemia being prevalent.

Findings:

  • MALA frequently occurs when metformin is prescribed inappropriately.
  • Risk factors include renal failure, cardiac failure, hypovolemia, and advanced age (>80 years).
  • Metformin cessation is crucial in acute hypovolemia or frail patients.

Implications:

  • Early recognition and discontinuation of metformin are vital.
  • Extrarenal blood purification may be necessary in emergency MALA cases.
  • Guidelines should emphasize careful patient selection and monitoring for metformin use.