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.