Endocrine Abstracts

Metformin Associated Lactic Acidosis (MALA) is defined by a Ph <7.35 and lactate levels greater than 5 mM. It must be distinguished from other lactic acidosis usually secondary to septic shock. Renal functional prognosis and mortality are not clearly separated in publications and many make the amalgam between the two entities with an estimated mortality of 30 to 50% and poor renal prognosis.

We did a retrospective, observational, cohort study of patients who were admitted consecutively in intensive care unit for MALA between January 2010 and July 2015 in a tertiary hospital.

Seventeen patients, nine men; mean age 60 years were included. The presumed cause of MALA was renal insufficiency by dehydration in seven, sepsis in seven, and voluntary intoxication in three.

The mean initial Ph was 7.05 (extreme 6.58 to 7.35), lactacidemia: 10.33 mM (extreme 5.12 to 15.2), creatinine was 551 μM (extreme 56 to 1338), blood glucose: 1.62 g/L (extreme 0.29 to 4.5). The ICU stay was of 10.2 days (extreme 1 to 26). Only two patients deceased because of septic shock. Fifteen had abnormal creatinine clearance <60 ml/min, 14 recovered of their renal insufficiency.

Eleven out of seventeen patients had dialysis to prevent the ionized calcium decrease, volume overload, hyperosmolality and remove metformin.

Thus at the opposite of Lactic Acidosis due to others causes, MALA represents a situation with good prognosis and rapid renal improvement by dialysis.