Copyright
©The Author(s) 2024.
World J Diabetes. Jun 15, 2024; 15(6): 1178-1186
Published online Jun 15, 2024. doi: 10.4239/wjd.v15.i6.1178
Published online Jun 15, 2024. doi: 10.4239/wjd.v15.i6.1178
Clinically relevant considerations | Lactic acidosis due to inadequate tissue oxygen supply to meet demand (Type A lactic acidosis) | Lactic acidosis due to mitochondrial dysfunction (Type B lactic acidosis) |
Selected causes | Hypovolemia/dehydration | Metformin toxicity |
Sepsis | Sepsis | |
Heart failure | Cyanide poisoning | |
Respiratory failure | ||
Clinical and laboratory features | Capillary refill time > 3 s | Capillary refill time 0-3 s |
ScvO2 < 70% | ScvO2 ≥ 70% and CO2 gap < 6 mmHg | |
ScvO2 ≥ 70% and CO2 gap > 6 mmHg | ||
Treatment | Fluid challenge, followed by fluid loading if capillary refill time or blood pressure improves | Stop further administration and consider extracorporeal removal of toxic agent (e.g., metformin) |
Empirical broad-spectrum antimicrobials for suspected sepsis | Empirical broad-spectrum antimicrobials for suspected sepsis | |
Vasopressors/inotropes to maintain a mean arterial pressure ≥ 65 mmHg | ||
Supplemental oxygen and mechanical ventilation to maintain an arterial oxygen saturation of 94%-98% | ||
Correct severe anemia and maintain hemoglobin 7-9 g/dL |
Risk factors | Mechanism |
Kidney failure (any cause) | Reduced renal elimination of metformin[45] |
Cimetidine | Reduced renal elimination of metformin[51] |
Ribociclib | Reduced renal elimination of metformin[52] |
Excessive alcohol consumption | Ethanol oxidation consumes nicotinamide adenine dinucleotides that are also required for lactate metabolism[50] |
- Citation: See KC. Metformin-associated lactic acidosis: A mini review of pathophysiology, diagnosis and management in critically ill patients. World J Diabetes 2024; 15(6): 1178-1186
- URL: https://www.wjgnet.com/1948-9358/full/v15/i6/1178.htm
- DOI: https://dx.doi.org/10.4239/wjd.v15.i6.1178