Symptoms of metformin lactic acidosis
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Symptoms of Metformin-Associated Lactic Acidosis (MALA)
Introduction to Metformin-Associated Lactic Acidosis
Metformin-associated lactic acidosis (MALA) is a rare but serious complication of metformin therapy, primarily used in the management of type 2 diabetes mellitus. This condition is characterized by elevated blood lactate levels and acidaemia, often leading to significant morbidity and mortality1 2 3. Understanding the symptoms of MALA is crucial for timely diagnosis and management.
Gastrointestinal Symptoms
Nausea, Vomiting, and Diarrhea
Gastrointestinal symptoms are the most common initial presentation in patients with MALA. Nearly all patients report experiencing nausea, vomiting, and diarrhea1 2 3. These symptoms are often severe and can lead to dehydration, which exacerbates the condition.
Abdominal Pain
Abdominal pain is another frequent symptom associated with MALA. Patients often describe the pain as severe and sharp, sometimes radiating to the lower back4. This pain can be a significant indicator of the underlying metabolic disturbance.
Systemic Symptoms
Fatigue and Weakness
Generalized fatigue and weakness are commonly reported by patients suffering from MALA. These symptoms are often accompanied by malaise and myalgia, contributing to the overall feeling of being unwell2 3.
Respiratory Distress
Patients with MALA may present with respiratory symptoms such as tachypnea (rapid breathing) due to the body's attempt to compensate for metabolic acidosis3. In severe cases, patients may require mechanical ventilation1.
Metabolic and Renal Symptoms
Severe Acidosis
One of the hallmark features of MALA is severe metabolic acidosis. Laboratory findings typically reveal a significantly low pH, high anion gap, and elevated lactate levels1 2 3. These findings are critical for the diagnosis and management of the condition.
Acute Renal Dysfunction
Acute renal dysfunction is frequently observed in patients with MALA. Elevated serum creatinine levels and reduced glomerular filtration rate (GFR) are common, indicating impaired kidney function1 2 3. This renal impairment can further complicate the clinical picture and necessitate interventions such as dialysis.
Conclusion
Metformin-associated lactic acidosis is a life-threatening condition that requires prompt recognition and management. The predominant symptoms include gastrointestinal disturbances (nausea, vomiting, diarrhea, abdominal pain), systemic symptoms (fatigue, weakness, respiratory distress), and significant metabolic and renal abnormalities (severe acidosis, acute renal dysfunction). Early identification and treatment are essential to improve outcomes in patients with MALA.
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Most relevant research papers on this topic
Metformin-associated lactic acidosis (MALA): clinical profile and outcomes in patients admitted to the intensive care unit.
Metformin-associated lactic acidosis (MALA) is a common cause of ICU admission, with gastrointestinal symptoms predominating and significant morbidity and mortality.
Observational StudyUnusual Case of Metformin-Associated Lactic Acidosis in Patient with Type 2 Diabetes Mellitus
Metformin-associated lactic acidosis (MALA) is a rare but life-threatening complication of metformin treatment, and patient compliance with taking metformin as prescribed is crucial for prevention and treatment.
Case ReportPSUN265 Metformin-Induced Severe Lactic Acidosis Requiring Urgent Dialysis Associated With Influenza A Infection in a Patient With Previous Preserved Renal Function: Case Report
Metformin-induced severe lactic acidosis can be fatal, even in patients with preserved renal function, and requires immediate recognition and management.
Case Report
Rigorous JournalSAT136 Severe Lactic Acidosis Due To Metformin Use.
Metformin use can cause severe lactic acidosis, which requires immediate emergency management to avoid further hemodynamic compromise.
Case ReportSevere metabolic acidosis due to massive metformin overdose in a man: a case report
A 43-year-old man with type II diabetes and opium addiction overdosed on metformin, leading to severe lactic acidosis and a successful outcome with prompt treatment.
Case Report[Metformin-induced lactic acidosis : Severe symptoms with difficult diagnostics].
Metformin-induced lactic acidosis is a rare but severe disease with difficult diagnostics, highlighting the need for careful monitoring and management of metformin administration during perioperative periods.
Case ReportLactic Acidosis Induced by Metformin
Metformin-associated lactic acidosis is rare and may even be protective in severe cases, but addressing liver disease severity and contraindications is crucial for effective patient management and prevention.
Literature Review
Highly CitedThe Association between Metformin Therapy and Lactic Acidosis
Metformin-associated lactic acidosis is associated with pre-existing risk factors and prescription doses that exceed guidelines in patients with renal impairment, but pre-admission plasma concentrations do not exceed the therapeutic range.
Systematic ReviewLactic Acidosis Associated with Metformin in Patients with Diabetic Kidney Disease
Metformin can increase lactate levels in chronic kidney disease patients, but these levels are still below the parameters of lactic acidosis.
Systematic ReviewMetformin-associated lactic acidosis: Current perspectives on causes and risk.
Metformin-associated lactic acidosis (MALA) is a rare but potentially fatal condition in type 2 diabetes patients, with current renal function cutoffs potentially being too conservative.
Literature ReviewHighly Cited