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World J Diabetes. Jun 15, 2024; 15(6): 1178-1186
Published online Jun 15, 2024. doi: 10.4239/wjd.v15.i6.1178
Metformin-associated lactic acidosis: A mini review of pathophysiology, diagnosis and management in critically ill patients
Kay Choong See
Kay Choong See, Department of Medicine, National University Hospital, Singapore 119228, Singapore
Author contributions: See KC is responsible for all elements of the manuscript.
Conflict-of-interest statement: Dr. See reports personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from GSK, personal fees from Novartis, outside the submitted work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kay Choong See, FCCP, FRCP, MBBS, MRCP, Adjunct Associate Professor, Department of Medicine, National University Hospital, Level 10, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore. kaychoongsee@nus.edu.sg
Received: December 24, 2023
Revised: April 4, 2024
Accepted: April 23, 2024
Published online: June 15, 2024
Processing time: 170 Days and 1.6 Hours
Core Tip

Core Tip: Metformin-associated lactic acidosis (MALA) in critically ill patients may be suspected in a patient who has received metformin and who has a high anion gap metabolic acidosis, and confirmed when lactate exceeds 5 mmol/L. Risk factors include those that reduce renal elimination of metformin and excessive alcohol consumption. Treatment of MALA involves immediate cessation of metformin, supportive management, treating other concurrent causes of lactic acidosis like sepsis, and treating any coexisting diabetic ketoacidosis. Severe MALA requires extracorporeal removal of metformin with either intermittent hemodialysis or continuous kidney replacement therapy.