Management of metformin-associated lactic acidosis by continuous renal replacement therapy.

<h4>Background</h4>Metformin-associated lactic acidosis (MALA) is a severe metabolic failure with high related mortality. Although its use is controversial, intermittent hemodialysis is reported to be the most frequently used treatment in conjunction with nonspecific supportive measures....

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Autores principales:	Geoffray Keller, Martin Cour, Romain Hernu, Julien Illinger, Dominique Robert, Laurent Argaud
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f0cf870f870b4bf986fa9fbd73824489
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spelling	oai:doaj.org-article:f0cf870f870b4bf986fa9fbd738244892021-11-18T06:48:11ZManagement of metformin-associated lactic acidosis by continuous renal replacement therapy.1932-620310.1371/journal.pone.0023200https://doaj.org/article/f0cf870f870b4bf986fa9fbd738244892011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21853087/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Metformin-associated lactic acidosis (MALA) is a severe metabolic failure with high related mortality. Although its use is controversial, intermittent hemodialysis is reported to be the most frequently used treatment in conjunction with nonspecific supportive measures. Our aim was to report the evolution and outcome of cases managed by continuous renal replacement therapy (CRRT).<h4>Methodology and principal findings</h4>Over a 3-year period, we retrospectively identified patients admitted to the intensive care unit for severe lactic acidosis caused by metformin. We included patients in our study who were treated with CRRT because of shock. We describe their clinical and biological features at admission and during renal support, as well as their evolution. We enrolled six patients with severe lactic acidosis; the mean pH and mean lactate was 6.92±0.20 and 14.4±5.1 mmol/l, respectively. Patients had high illness severity scores, including the Simplified Acute Physiology Score II (SAPS II) (average score 63±12 points). Early CRRT comprised either venovenous hemofiltration (n = 3) or hemodiafiltration (n = 3) with a mean effluent flow rate of 34±6 ml/kg/h. Metabolic acidosis control and metformin elimination was rapid and there was no rebound. Outcome was favorable in all cases.<h4>Conclusions and significance</h4>Standard use of CRRT efficiently treated MALA in association with symptomatic organ supportive therapies.Geoffray KellerMartin CourRomain HernuJulien IllingerDominique RobertLaurent ArgaudPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 8, p e23200 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Geoffray Keller Martin Cour Romain Hernu Julien Illinger Dominique Robert Laurent Argaud Management of metformin-associated lactic acidosis by continuous renal replacement therapy.
description	<h4>Background</h4>Metformin-associated lactic acidosis (MALA) is a severe metabolic failure with high related mortality. Although its use is controversial, intermittent hemodialysis is reported to be the most frequently used treatment in conjunction with nonspecific supportive measures. Our aim was to report the evolution and outcome of cases managed by continuous renal replacement therapy (CRRT).<h4>Methodology and principal findings</h4>Over a 3-year period, we retrospectively identified patients admitted to the intensive care unit for severe lactic acidosis caused by metformin. We included patients in our study who were treated with CRRT because of shock. We describe their clinical and biological features at admission and during renal support, as well as their evolution. We enrolled six patients with severe lactic acidosis; the mean pH and mean lactate was 6.92±0.20 and 14.4±5.1 mmol/l, respectively. Patients had high illness severity scores, including the Simplified Acute Physiology Score II (SAPS II) (average score 63±12 points). Early CRRT comprised either venovenous hemofiltration (n = 3) or hemodiafiltration (n = 3) with a mean effluent flow rate of 34±6 ml/kg/h. Metabolic acidosis control and metformin elimination was rapid and there was no rebound. Outcome was favorable in all cases.<h4>Conclusions and significance</h4>Standard use of CRRT efficiently treated MALA in association with symptomatic organ supportive therapies.
format	article
author	Geoffray Keller Martin Cour Romain Hernu Julien Illinger Dominique Robert Laurent Argaud
author_facet	Geoffray Keller Martin Cour Romain Hernu Julien Illinger Dominique Robert Laurent Argaud
author_sort	Geoffray Keller
title	Management of metformin-associated lactic acidosis by continuous renal replacement therapy.
title_short	Management of metformin-associated lactic acidosis by continuous renal replacement therapy.
title_full	Management of metformin-associated lactic acidosis by continuous renal replacement therapy.
title_fullStr	Management of metformin-associated lactic acidosis by continuous renal replacement therapy.
title_full_unstemmed	Management of metformin-associated lactic acidosis by continuous renal replacement therapy.
title_sort	management of metformin-associated lactic acidosis by continuous renal replacement therapy.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/f0cf870f870b4bf986fa9fbd73824489
work_keys_str_mv	AT geoffraykeller managementofmetforminassociatedlacticacidosisbycontinuousrenalreplacementtherapy AT martincour managementofmetforminassociatedlacticacidosisbycontinuousrenalreplacementtherapy AT romainhernu managementofmetforminassociatedlacticacidosisbycontinuousrenalreplacementtherapy AT julienillinger managementofmetforminassociatedlacticacidosisbycontinuousrenalreplacementtherapy AT dominiquerobert managementofmetforminassociatedlacticacidosisbycontinuousrenalreplacementtherapy AT laurentargaud managementofmetforminassociatedlacticacidosisbycontinuousrenalreplacementtherapy
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Management of metformin-associated lactic acidosis by continuous renal replacement therapy.

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