There is an observed association between lactic acidosis and metformin. At usual dose and normal renal function, lactic acidosis is unlikely with metformin therapy. Only when renal function deteriorates leading to accumulation of the drug that metformin is capable of inducing B type lactic acidosis in a similar way that an overdose of metformin causes it even if renal function is normal. When a diabetic patient on metformin has a vomiting and diarrhoeal illness, the drug should be stopped until the patient is well again. This patient may still have some metformin on board and may take up to 48 - 72 hours to clear. They may need renal support if anuric as metformin is renally cleared. And always look for other causes such as bowel ischaemia if the LA doesn't resolve with fluid and renal support therapy.
Regards
Mohammad
Dr. M A Al-Jubouri, MB ChB, MSc, EurClinChem, FRCP Edin, FRCPath
Consultant Chemical Pathologist
--- On Wed, 19/6/13, Jonathan Kay wrote:
> From: Jonathan Kay
> Subject: Re: Lactic acidosis following metform
> To: [log in to unmask]
> Date: Wednesday, 19 June, 2013, 18:15
> The rôle of metformin in lactic
> acidosis is controversial.
>
> What other factors that could have caused the deterioration
> were originally present, and which are present now?
>
> Jonathan
>
>
>
> On 19 Jun 2013, at 18:04, Jones, Alison wrote:
>
> > Advice from the collective brain please - I don't have
> too many details
> > to hand, I'm afraid.
> >
> > Patient on ICU. Metformin stopped 36h ago, but
> lactic acidosis getting
> > progressively worse (most recent lactate >11
> mmol/L). Creatinine =
> > 130umol/L.
> >
> > Is lactic acidosis likely to be due to metformin (i.e.
> can effects be
> > persistent) or should we be looking for another cause?
> >
> > Many thanks
> >
> > Alison Jones
> >
> > ------ACB discussion List Information--------
> > This is an open discussion list for the academic and
> clinical community working in clinical biochemistry.
> > Please note, archived messages are public and can be
> viewed via the internet. Views expressed are those of the
> individual and they are responsible for all message
> content.
> > ACB Web Site
> > http://www.acb.org.uk
> > Green Laboratories Work
> > http://www.laboratorymedicine.nhs.uk
> > List Archives
> > http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
> > List Instructions (How to leave etc.)
> > http://www.jiscmail.ac.uk/
>
> ------ACB discussion List Information--------
> This is an open discussion list for the academic and
> clinical community working in clinical biochemistry.
> Please note, archived messages are public and can be viewed
> via the internet. Views expressed are those of the
> individual and they are responsible for all message
> content.
> ACB Web Site
> http://www.acb.org.uk
> Green Laboratories Work
> http://www.laboratorymedicine.nhs.uk
> List Archives
> http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
> List Instructions (How to leave etc.)
> http://www.jiscmail.ac.uk/
>
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical community working in clinical biochemistry.
Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
Green Laboratories Work
http://www.laboratorymedicine.nhs.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
|