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Metformin-Associated Lactic Acidosis

1998; American Board of Family Medicine; Volume: 11; Issue: 3 Linguagem: Inglês

10.3122/15572625-11-3-233

1558-7118

Darrell Hulisz, Mark F. Bonfiglio, R.Daniel Murray,

Pancreatitis Pathology and Treatment

Metformin is a biguanide used to lower blood glucose levels in patients with non-insulin-dependent diabetes mellitus (NIDDM). Metformin notably has certain advantages over sulfonylureas because it does not cause hypoglycemia, nor does it promote weight gain or hyperinsulinemia.1 It also appears to have beneficial effects on blood lipid levels.2 Because of these advantages, metformin use is widely promoted, particularly to primary care physicians, and it will likely be used extensively in this country for treatment ofNIDDM. Nevertheless, a potential complication of metformin use is its rare association with lactic acidosis, a condition that has a mortality rate of approximately 50 percent.3,4 Accordingly, it is instructive to describe a case of metformin-associated lactic acidosis. This condition developed in a patient who had no obvious risks for lactic acidosis (eg, renal failure). Several teaching points emerge from this case report that have important implications for metformin use, including altered physiology secondary to patient comorbidity, and potential for metformin-drug interactions. This case underscores important patient considerations related to metformin prescribing.