Case ReportMetformin-Induced Lactic Acidosis (MILA): Review of current diagnostic paradigm☆
Section snippets
Case
A 45-year-old male with type 2 diabetes, hypertension, chronic kidney disease stage 2, bipolar disorder and substance abuse presents to the emergency department with 1-day history of nausea, vomiting, abdominal pain and appetite loss. Review of systems was otherwise negative except he had difficulty sleeping, therefore, was prescribed Trazodone 300 mg nightly by his psychiatrist (started three nights prior). On presentation, rectal temperature was 92.7 °F, pulse 86 beats per minute, respiratory
Discussion
Metformin is absorbed by enterocytes in the small intestine and delivered to liver via portal vein. Before leaving the intestine, Metformin increases production of lactate by promoting glycolysis and changing glucose metabolism from aerobic to anaerobic pathways [2,3]. A well-controlled type 2 diabetic, without renal impairment, taking Metformin appropriately will have inhibition of gluconeogenesis to prevent hyperglycemia, but will not have enough effect to produce significant lactate [4]. In
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2023, American Journal of Emergency MedicineMetformin lactic acidosis: Should we still be afraid?
2019, Diabetes Research and Clinical PracticeCitation Excerpt :Without these, particularly if circulating metformin level is missing, it is impossible to distinguish between LA by metformin accumulation in the setting of overdosing or kidney failure and LA by systemic conditions (sepsis, cardiac failure, haemorrhage, etc.) in a patient taking metformin in which biguanide use may be merely concomitant, without any causal role [22]. To better categorize LA causes, a diagnostic paradigm has been proposed by Krowl et al., according to which a causal link with metformin may be defined if lactate is >5 mmol/L, pH < 7.35 and metformin circulating level >5 mg/L [23]. Unfortunately, metformin assay is not readily available in emergency wards, thereby making this classification tool difficult to use in today's clinical practice.
Reversible Acute Blindness in Suspected Metformin-Associated Lactic Acidosis
2019, Journal of Emergency MedicineCitation Excerpt :It is, therefore, impossible to measure blood concentrations of metformin in routine clinical practice. Consequently, MALA should be suspected in patients with a history of metformin intake, irrespective of whether plasma levels of metformin are known (17–20). In our case, although the plasma concentration of metformin was not estimated, treatment for MALA was instituted immediately, based on the history of metformin intake, the presence of metabolic acidosis, and renal insufficiency, with successful results.
Reversible acute blindness in suspected metformin-associated lactic acidosis: a case report
2023, Journal of Medical Case ReportsReversible Acute Blindness in Suspected Metformin- Associated Lactic Acidosis
2023, Research SquareMetformin in therapeutic applications in human diseases: its mechanism of action and clinical study
2022, Molecular Biomedicine
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The authors declare no conflict of interest.
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