Anestéziológia a intenzívna medicína 2/2018

Life – threatening lactic acidosis

We present a case report of successful treatment of life-threatening metformin lactic acidosis (MALA) with pH 6,7 and serum lactate 26 mmol/l at admission. Because of inadequate response to standard treatment continuous veno-venous hemodiafiltration was used. Metformin has become a drug of choice for the treatment of type II diabetes mellitus. For some patients with risk of metabolic acidosis, however, is not appropriate. Metformin as other biguanids inhibits mitochondrial respiration and in this way increases plasma lactate level. MALA is associated with impaired renal functions or in situations increased lactate production or lowered elimination (sepsis,cirhosis). In these group is treatment with biguanides contraindicated. Incidence of MALA in clinical practice is lower than 3-5 : 100 000.

Keywords: metformin, lactic acidosis