Lactic acidosis in metformin therapy: searching for a link with metformin in reports of 'metformin-associated lactic acidosis'.

摘要: SUMMARY Objective  The link between metformin and lactic acidosis in therapy may be causal, associated or coincidental. Our objective was to investigate this by studying analysing published reports of so-called ‘metformin-associated acidosis’. Research design methods  systematically searched the BIOSIS, DERWENT, EMBASE, MEDLINE, PASCAL databases English language non-English literature for all acidosis’ from May 1995 through January 2000. We did not include related overdose contrast media-induced renal failure. Metformin accumulation concurrent pathologies were critically reviewed as precipitating factors metformin-associated acidosis. assessed terms recorded measurement concentration plasma or, if available, presence primary failure, i.e. failure that secondary a shock syndrome. Results  found 21 describing total 26 patients. Criteria (lactate > 5 mmol/l, pH ≤ 7.35) met four In remaining 22 patients, determined only four, whom one had normal value. 18 patients with where data absent unlikely six uncertain two, likely proven 14. With regard these 14 factor 12 (in context either chronic acute) intercurrent two others. Overall, (n = 4), precipitated pathology (n = 8), without apparent (n = 12) origin (n = 2). Death occurred 10 times but once metformin-induced metformin. Conclusions  While term is commonly used depict situations therapy, true acidosis, which refers co-precipitating factors, never observed studied reports. As there no mortality due alone, it important physicians are familiar range other risk contribute treated metformin.