A 56-year-old woman, with no predisposing disease, died from lactic acidosis following majorĮmma Fitzgerald, specialist trainee year 2 in anaesthetics 1, Stephen Mathieu, specialist registrar in anaesthetics and intensive care medicine1, Andrew Ball, consultant in anaesthesia and intensive care medicine1 1Dorset County Hospital, Dorchester, Dorset DT1 2JY Correspondence to: E Fitzgerald Dehydration in patients taking metformin can lead to metformin associated lactic acidosis, a potentially fatal condition Metformin, a dimethylbiguanide, is a widely used oral antihyperglycaemic drug used in the long term treatment of type 2 diabetes mellitus. ![]() Post-surgical lactic acidosis caused the death of a 70-year-old man whose metformin was not withdrawn at the time of surgery. He was well for six weeks, then developed lactic acidosis and died within 3 days. patient-years, mostly in patients with predisposing factors.1 Examples of metformin-induced lactic acidosis cases reported to CARM include: A 69-year-old man, with renal and cardiac disease, was prescribed metformin due to failing glycaemic control on glibenclamide monotherapy. The reported frequency of lactic acidosis is 0. Lactic acidosis is an uncommon but potentially fatal adverse effect. Metformin useful but small risk of potentially fatal lactic acidosis Metformin is a useful therapeutic agent for obese non-insulin dependent diabetics and those whose glycaemia cannot be controlled by sulphonylurea monotherapy. Of the 12 cases of lactic acidosis associated with metformin reported to CARM since 1977, 2 occurred in the last year and 8 cases had a fatal outcome. ![]() Metformin remains a major reported cause of drug-associated mortality in New Zealand. Other risk factors for metformin-induced lactic acidosis are sepsis, dehydration, high dosages and increasing age. cardiac and pulmonary disease, surgery) are contraindications to the use of metformin. ![]() Significant renal and hepatic disease, alcoholism and conditions associated with hypoxia (eg. Dr P Pillans,former Medical Assessor, Centre for Adverse Reactions Monitoring (CARM), Dunedin Metformin is a useful anti-hyperglycaemic agent but significant mortality is associated with drug-induced lactic acidosis. Publications Published: July 1998 Information on this subject has been updated.
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