Abstract

PurposeTo assess whether extracorporeal treatment (ECTR) improves outcome of patients with metformin-associated lactic acidosis (MALA) and to evaluate the clinical applicability of the Extracorporeal Treatments in Poisoning Workgroup (EXTRIP) criteria for starting ECTR in metformin poisoning.MethodsPatients with metformin serum concentrations above 2 mg/l who were admitted in the Deventer Teaching Hospital between January 2000 and July 2019 and complied with the definition of MALA (pH < 7.35 and lactate concentration > 5 mmol/l) were included. Mortality and clinical parameters of patients treated with ECTR or not were compared. In addition, treatment of MALA in clinical practice was verified against the criteria of EXTRIP.ResultsForty-two patients were included. Lactate (13.8 versus 10.5 mmol/l, p = 0.01), creatinine (575 versus 254 umol/l, p < 0.01)), metformin (29.4 versus 8.6 mg/l, p < 0.01) concentrations, and vasopressor requirement (72% versus 23%, p < 0.01) were significantly higher in the ECTR-group. Blood pH (7.05 versus 7.19, p = 0.03) and bicarbonate (6 versus 11 mmol/l, p < 0.01) were significantly lower. Mortality, length of hospital stay, and mechanical ventilation requirement were not statistically different. In 83% of patients, treatment of MALA was in accordance with the EXTRIP criteria.ConclusionsAlthough there was no statistical benefit in mortality shown from ECTR, ECTR might be lifesaving in MALA, considering the ECTR-group was significantly sicker than the non-ECTR-group.The majority of patients were treated in line with the EXTRIP criteria. Severity of lactic acidosis and renal impairment were the main indications for initiating ECTR.

Highlights

  • Metformin is the most commonly prescribed oral antidiabetic drug in non-insulin-dependent type 2 diabetes mellitus (NIDDM)

  • Severity of lactic acidosis and renal impairment were the main indications for initiating Extracorporeal treatments (ECTRs)

  • In our hospital pharmacy laboratory database, we identified 160 patients who had serum metformin concentrations measured

Read more

Summary

Introduction

Metformin is the most commonly prescribed oral antidiabetic drug in non-insulin-dependent type 2 diabetes mellitus (NIDDM). Facilitates cellular glucose uptake, and decreases insulin resistance [1]. Metformin treatment is associated with a lower incidence of cardiovascular events and mortality in NIDDM [2]. The most widely accepted mechanism how metformin causes hyperlactatemia and metabolic acidosis is by partial inhibition of oxidative phosphorylation complex 1 of the mitochondrial electron transport chain. Another possible mechanism in which metformin may elevate plasma lactate levels is through inhibition of pyruvate carboxylase which results in both

Objectives
Methods
Results
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call