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- Title
Combined metformin-associated lactic acidosis and euglycemic ketoacidosis.
- Authors
Schwetz, Verena; Eisner, Florian; Schilcher, Gernot; Eller, Kathrin; Plank, Johannes; Lind, Alice; Pieber, Thomas; Mader, Julia; Eller, Philipp
- Abstract
Background: In renal failure metformin can lead to lactic acidosis. Additional inhibition of hepatic gluconeogenesis by accumulation of the drug may aggravate fasting-induced ketoacidosis. We report the occurrence of metformin-associated lactic acidosis (MALA) with concurrent euglycemic ketoacidosis (MALKA) in three patients with renal failure. Case presentations: Patient 1: a 78-year-old woman (pH = 6.89, lactic acid 22 mmol/l, serum ketoacids 7.4 mmol/l and blood glucose 63 mg/dl) on metformin and insulin treatment. Patient 2: a 79-year-old woman on metformin treatment (pH = 6.80, lactic acid 14.7 mmol/l, serum ketoacids 6.4 mmol/l and blood glucose 76 mg/dl). Patient 3: a 71-year-old man on metformin, canagliflozin and liraglutide treatment (pH = 7.21, lactic acid 5.9 mmol/l, serum ketoacids 16 mmol/l and blood glucose 150 mg/dl). In all patients, ketoacidosis receded on glucose infusion and renal replacement therapy. Conclusion: This case series highlights the parallel occurrence of MALA and euglycemic ketoacidosis, the latter exceeding ketosis due to starvation, suggesting a metformin-triggered inhibition of gluconeogenesis. Affected patients benefit from glucose infusion counteracting suppressed hepatic gluconeogenesis.
- Subjects
KIDNEY failure; KETOACIDOSIS treatment; LACTIC acidosis; TYPE 2 diabetes; METFORMIN; CANAGLIFLOZIN; THERAPEUTICS; DISEASE risk factors
- Publication
Wiener Klinische Wochenschrift, 2017, Vol 129, Issue 17/18, p646
- ISSN
0043-5325
- Publication type
Article
- DOI
10.1007/s00508-017-1251-6