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Acta medica Croatica : Časopis Akademije medicinskih znanosti Hrvatske, Vol. 71 No. 4, 2017.

Review article

METFORMIN-INDUCED LACTIC ACIDOSIS: ARE WE UP TO THE CHALLENGE OF A GROWING PROBLEM?

LUKA VIDOVIĆ orcid id orcid.org/0000-0001-9673-1446 ; Department of Nephrology and Dialysis, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
DAJANA KATIČIĆ orcid id orcid.org/0000-0002-3610-4560 ; Department of Nephrology and Dialysis, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
SINIŠA ŠEFER orcid id orcid.org/0000-0001-6072-2492 ; Department of Nephrology and Dialysis, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia

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Abstract

Metformin-induced lactic acidosis is an uncommon, life-threatening complication occurring in patients with impaired kidney function. It develops as a result of metformin accumulation due to the inability of renal excretion and the imbalance of lactate metabolism, resulting in severe metabolic acidosis. Various studies have shown a small incidence of this complication as opposed to the large number of patients taking metformin. Provided the strict dosage measures are implemented, metformin has been shown to be a safe drug. However, any acute illness resulting in rapid kidney function deterioration can lead to this severe complication, even in patients with normal initial renal function. Based on our clinical experience in treating this severe side effect, we conclude that any severe lactic acidosis in patients with type 2 diabetes treated with metformin, with impaired renal function should be understood as metformin-induced lactic acidosis, and all available intensive care measures should be taken. Hemodialysis in its different forms (intermittent or continuous) plays a key role in the treatment, whereby it is important to appropriately select solutions that should not contain lactate. Due to the high mortality, metformin-induced lactic acidosis remains a major therapeutic problem, as well as a challenge in implementing preventive measures by family physicians and diabetologists.

Keywords

metformin; adverse effects; lactic acidosis; kidney failure; treatment

Hrčak ID:

193712

URI

https://hrcak.srce.hr/193712

Publication date:

15.2.2018.

Article data in other languages: croatian

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