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Phenformin and lactic acidosis

P H Wise, M Chapman, D W Thomas

    British Medical Journal
    |January 10, 1976
    PubMed
    Summary
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    Phenformin use in diabetic patients with altered consciousness and lactic acidosis may indicate multifactorial causes, especially with coexisting renal or cardiovascular issues. Advanced age and these conditions are contraindications for phenformin.

    Area of Science:

    • Endocrinology
    • Nephrology
    • Cardiology

    Background:

    • Lactic acidosis is a serious complication in diabetic patients.
    • Phenformin, a medication previously used for diabetes, has been associated with lactic acidosis.
    • Identifying contributing factors is crucial for patient management.

    Purpose of the Study:

    • To investigate the aetiology of lactic acidosis in diabetic patients, particularly those on phenformin.
    • To determine risk factors and contraindications for phenformin use in this population.

    Main Methods:

    • Retrospective analysis of 38 diabetic patients meeting lactic acidosis criteria.
    • Detailed review of patient histories, including medication use (phenformin) and comorbidities.
    • Assessment for renal and cardiovascular abnormalities.

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    Main Results:

    • Sixteen patients presented with non-ketotic lactic acidosis.
    • Fifteen of these non-ketotic patients were on phenformin.
    • Comorbidities like renal or cardiovascular disease were present in 14 of the 15 phenformin patients, suggesting multifactorial aetiology.
    • Advanced age, cardiovascular disease, and renal disease were identified as contraindications.

    Conclusions:

    • Phenformin-associated lactic acidosis in diabetics is often multifactorial, linked to underlying renal or cardiovascular compromise.
    • Phenformin should be contraindicated in diabetic patients with advanced age, cardiovascular disease, or renal disease.
    • Careful patient selection and monitoring are essential when considering phenformin therapy.