L’Acidose Lactique Induite Par La Phenformine. A Propos De 8 Observations

Abstract

SummaryEight cases of phenformin-induced lactic acidosis arc reviewed. The clinical picture was typical : digestive complains were associated with impairment of consciousness, hypothermia and shock. All patients exhibited deep metabolic acidosis (mean arterial pH : 6.86), with a wide anion gap, and increased values for arterial-blood lactate (mean : 26 mEq/L) and pyruvate. Hypoglycemia was noted in 3 cases. Serum amylases were very high in two cases, making it difficult the differentiation with acute pancreatitis as the cause of lactic acidosis. In all instances, the phenformin-therapy was associated with chronic renal insufficiency ; another factor of drug overdosage was associated in most cases. Despite intensive treatment, all but one patients died from the lactic acidosis. The pathophysiological mechanism of phenformin-induced lactic acidosis is discussed, and a treatment schema is proposed from a review of the literature.