Metformin-associated lactic acidosis in an intensive care unit.

Abstract:

INTRODUCTION:Metformin-associated lactic acidosis (MALA) is a classic side effect of metformin and is known to be a severe disease with a high mortality rate. The treatment of MALA with dialysis is controversial and is the subject of many case reports in the literature. We aimed to assess the prevalence of MALA in a 16-bed, university-affiliated, intensive care unit (ICU), and the effect of dialysis on patient outcome. METHODS:Over a five-year period, we retrospectively identified all patients who were either admitted to the ICU with metformin as a usual medication, or who attempted suicide by metformin ingestion. Within this population, we selected patients presenting with lactic acidosis, thus defining MALA, and described their clinical and biological features. RESULTS:MALA accounted for 0.84% of all admissions during the study period (30 MALA admissions over five years) and was associated with a 30% mortality rate. The only factors associated with a fatal outcome were the reason for admission in the ICU and the initial prothrombin time. Although patients who went on to haemodialysis had higher illness severity scores, as compared with those who were not dialysed, the mortality rates were similar between the two groups (31.3% versus 28.6%). CONCLUSIONS:MALA can be encountered in the ICU several times a year and still remains a life-threatening condition. Treatment is restricted mostly to supportive measures, although haemodialysis may possess a protective effect.

journal_name

Crit Care

authors

Peters N,Jay N,Barraud D,Cravoisy A,Nace L,Bollaert PE,Gibot S

doi

10.1186/cc7137

subject

Has Abstract

pub_date

2008-01-01 00:00:00

pages

R149

issue

6

eissn

1364-8535

issn

1466-609X

pii

cc7137

journal_volume

12

pub_type

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