Metformin associated lactic acidosis

Lactic acidosis is serious acid-base balance disorder, that can occur in patients on metformin therapy. Metformin is currently still one of the most used drugs in the treatment of the type 2 diabetes mellitus. Metformin is still one of the most commonly used drug in therapy of Diabettes Mellitus type 2. The aim of this algorithm is to encounter the solver with this condition and its correct therapy.

lactic acidosis
type 2 diabetes mellitus
Published at: 7.5.2020


Jan Beneš, MD, MSc
Senior ICU Consultant ICU, Department of Anesthesiology, Perioperative and Intensive medicine, Krajská zdravotní a.s. - Masaryk hospital in Ústí nad Labem o.z., Ústí nad Labem, Czech Republic

Metformin-associated lactic acidosis (MALA) is a rare complication of treatment with this antidiabetic drug associated with mortality in the range of tens of percents. Making the correct diagnosis can be difficult due to the wide differential diagnosis of hyperlactatemia and circulatory shock. However, with early detection and proper treatment, the prognosis of MALA is significantly better than the prognosis of lactic acidosis of the same severity but different etiology. The presented algorithm shows in a simple and clear way the basic principles of MALA treatment, which are a complex mechanical and pharmacological support of organ functions and elimination of metformin by hemodialysis. The fact that the triggering mechanism of this condition is often infection and dehydration is also very well illustrated.


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