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SHR Neuro Cancer Cardio Lipid Metab Microb
Schwetz, V; Eisner, F; Schilcher, G; Eller, K; Plank, J; Lind, A; Pieber, TR; Mader, JK; Eller, P.
Combined metformin-associated lactic acidosis and euglycemic ketoacidosis.
Wien Klin Wochenschr. 2017; 129(17-18):646-649
Doi: 10.1007/s00508-017-1251-6
(- Case Report)
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- Leading authors Med Uni Graz
- Mader Julia
- Theiler-Schwetz Verena
- Co-authors Med Uni Graz
- Eisner Florian
- Eller Kathrin
- Eller Philipp
- Lind Alice Florentina
- Pieber Thomas
- Schilcher Gernot
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- 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.
- Find related publications in this database (using NLM MeSH Indexing)
- Acidosis, Lactic - chemically induced
- Aged - administration & dosage
- Blood Glucose - metabolism
- Canagliflozin - adverse effects, therapeutic use
- Diabetes Mellitus, Type 2 - blood, drug therapy
- Drug Therapy, Combination - administration & dosage
- Female - administration & dosage
- Gluconeogenesis - drug effects
- Humans - administration & dosage
- Insulin - adverse effects, therapeutic use
- Ketosis - chemically induced
- Kidney Failure, Chronic - complications
- Liraglutide - adverse effects, therapeutic use
- Male - administration & dosage
- Metformin - adverse effects, therapeutic use
- Find related publications in this database (Keywords)
- Ketoacidosis
- Type 2 diabetes
- Metformin
- Lactic acidosis