Metformin-associated lactic acidosis precipitated by acute renal failure

In type II diabetes treated with metformin, lactic acidosis is a rare but severe complication. Commonly patients with lactic acidosis show signs of shock, tissue hypoxia, acute hepatic or renal failure and the link between metformin therapy and lactic acidosis may be coincidental, associated or caus...

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Bibliographic Details
Published in:Annales françaises d'anesthésie et de réanimation 2003-05, Vol.22 (5), p.457
Main Authors: Pertek, J P, Vidal, S, Mariot, J, Galy-Floc'h, M, Azoulay, E
Format: Article
Language:fre
Subjects:
Acidosis, Lactic - blood
Acidosis, Lactic - chemically induced
Acidosis, Lactic - physiopathology
Acute Kidney Injury - blood
Acute Kidney Injury - complications
Acute Kidney Injury - physiopathology
Aged
Blood Gas Analysis
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - drug therapy
Female
Humans
Hypoglycemic Agents - adverse effects
Hypoglycemic Agents - therapeutic use
Lactic Acid - blood
Metformin - adverse effects
Metformin - therapeutic use
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Summary:In type II diabetes treated with metformin, lactic acidosis is a rare but severe complication. Commonly patients with lactic acidosis show signs of shock, tissue hypoxia, acute hepatic or renal failure and the link between metformin therapy and lactic acidosis may be coincidental, associated or causal. Excessive plasma metformin concentrations show that lactic acidosis is due to a toxicological mechanism. The case of a 65-year-old woman with type II diabetes, in whom severe type B2 lactic acidosis secondary to metformin was precipitated by acute renal failure, is presented. The association of diuretics with non-steroidal anti-inflammatory drugs and colchicine was responsible for a volume depletion and an acute renal failure. Initial serum creatinine was 643 micromol x l(-1) and arterial blood gas analysis revealed a pH of 7.01. Aggressive volume expansion and correction of the acidosis with intravenous bicarbonate therapy failed. At the intensive care unit, calculated anion gap was 35 mmol x l(-1) (normal range 10-18) and lactate concentration was 12.4 mmol x l(-1), liver profile was normal. Prolonged haemodialysis using bicarbonate dialysate resulted in a favourable outcome. Toxicology confirmed retrospectively the presence of a plasma concentration of metformine of 20 mg x l(-1) (normal
ISSN:0750-7658
DOI:10.1016/S0750-7658(03)00066-2