It is a form of metabolic acidosis, in which excessive acid accumulates due to a problem with the bodys oxidative metabolism. Scribd is the worlds largest social reading and publishing site. Acidosis lactica por metformina desencadenada por una insuficiencia renal aguda. Pdf although metformin has become a drug of choice for the treatment of type 2 diabetes mellitus, some patients may not receive it owing to. Ba sed on this classification, it may establish the most appropriate treatment. The symptoms are generally attributable to these underlying causes, but may include nausea, vomiting, kussmaul breathing laboured and deep, and generalised weakness. Metabolic acidosis is defined as an arterial blood ph acidosis. Lactic acidosis is a medical condition characterized by the buildup of lactate especially llactate in the body, with formation of an excessively low ph in the bloodstream. In conclusion, 1 bicarbonate dialysis is an adequate treatment of lactic acidosis observed in diabetic patients treated with metformin since it rapidly corrects the acidbase disorders and. The alimarc2 study is a casecontrol study to assess the association between metformin and lactic acidosis in patients with type 2 diabetes mellitus and moderatesevere chronic kidney disease. From the clinical point of view, it must be suspected in a patient with non well explained metabolic acidosis and a high anion gap, which is over 2530 meql, even in presence of r enal. Pdf this paper reports the case of a 72yearold female patient with type 2 diabetes mellitus treated with metformin. Lactic acidosis is typically the result of an underlying acute or chronic medical condition, medication, or poisoning.
Preclinical studies also indicate that increased plasma lactate concentrations and lactic acidosis are related to biguanide dose and plasma levels, with phenformin being the most potent, followed by buformin, and metformin. Acidosis lactica acido lactico especialidades medicas. Although its use is controversial, intermittent hemodialysis is reported to be the most frequently used treatment in conjunction with nonspecific supportive measures. Management of metforminassociated lactic acidosis by. Metforminassociated lactic acidosis is a severe and infrequent adverse event. Metforminassociated lactic acidosis mala is a severe metabolic failure with high related mortality. Acidosis lactica por metformina desencadenada por una. First, this potential event still influences treatment strategies in type 2 diabetes mellitus, particularly in the many patients at risk of kidney failure, in those presenting contraindications to metformin and in the elderly. Lactic acidosis is a serious but uncommon side effect of metformin use. Report of one case metforminassociated lactic acidosis is a severe and infrequent adverse event.
Acidosis lactica grave asociada a intoxicacion por metformina. Trastornos del metabolismo acidobase nefrologia al dia. The causes of lactic acidosis are divided into those caused by hystic hypoxia type a and those not caused by this disorder type b such as lactic acidosis due to systemic disorders, use of drugs or toxins and acidosis resulting from inborn metabolic errors. It has been documented exclusively in case reports and small case series.
Puede deberse a insuficiencia hepatocelular grave o a. However, the information available in patients with moderatesevere chronic kidney disease is scarce. Nov 21, 2012 lactic acidosis associated with metformin treatment is a rare but important adverse event, and unravelling the problem is critical. Lactate levels greater than 2 mmoll represent hyperlactatemia, whereas lactic acidosis is generally defined as a serum lactate concentration above 4 mmoll. The incidence of lactic acidosis with metformin is estimated to be 20 times less than with phenformin. Sotomayor hernandez ce, pardo carrero mr, olarter mf. Metformininduced lactic acidosis due to acute renal. Lactic acidosis is the most common cause of metabolic acidosis in hospitalized patients. We discuss the pathophysiological mechanisms of lactic acidosis with particular regard to the role played by the drug as a potential cause of the entity. Lactic acidosis associated with metformin in patients with. Acidosis lactica y choque distributivo por sobredosis. We identified 84 original reports published between 1977 and 2017. Holanda pena ms, suberviola canas b, gonzalez castro a, marco moreno jm, ugarte pena p. May 30, 2019 the use of metformin in patients with type 2 diabetes mellitus has been associated with lactic acidosis.
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