Letter to the Editor

Metformin-associated Lactic Acidosis in a Patient with Vertebral Artery Dissection

Authors: Clifford D. Packer, MD

Abstract

Metformin, a biguanide antidiabetic drug, has been implicated as a cause of lactic acidosis, usually in a setting of renal failure, IV contrast administration, shock, sepsis, hypoxemia, heart failure, or liver disease. Although metformin can cause mild lactic acidemia in type 2 diabetes mellitus patients with normal renal function,1,2 there are very few reports of lactic acidosis (blood lactate >5 mEq/L, anion gap >15, arterial pH <7.35) in patients with normal renal function and no other obvious precipitating cause. In the following case, a metformin-treated man with mild and limited stroke symptoms and normal renal function developed lactic acidosis in the absence of other risk factors.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Abbasi AA, Kasmikha R, Sotingeanu DG. Metformin-induced lacticacidemia in patients with type 2 diabetes mellitus. Endocr Pract 2000;6:442–446.
 
2. Khan JK, Pallaki M, Tolbert SR, et al. Lactic acidemia associated with metformin. Ann Pharmacother2003;37:66–69.
 
3. Stades AM Heikens JT, Erkelens DW et al. Metformin and lactic acidosis: cause or coincidence? A review of case reports. J Intern Med 2004;255:179–187.
 
4. Al-Jebawi AF, Lassman MN, Abourizk NN. Lactic acidosis with therapeutic metformin blood level in a low-risk diabetic patient. Diabetes Care 1998;21:1364–1365.
 
5. Matsumoto J, Saver JL, Brennan KC, et al. Mitochondrial encephalomyopathy with lactic acidosis and stroke (MELAS). Rev Neurol Dis 2005;2:30–34.
 
6. Trofymova IM Dosenko VIe, Byts' IuV. [Activity of elastase and its inhibitors in tissues of aorta and blood serum in various types of acidosis] Fiziol Zh 2001;47:24–29.