| Metformin and lactic acidosis: cause or coincidence? A review of case reports. | |
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MedLine Citation:
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PMID: 14746555 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Metformin has been associated with the serious side-effect lactic acidosis. However, it remains unclear whether the use of metformin was a cause or a coincidence in lactic acidosis. DESIGN: A literature search of the Index Medicus (1959-66) and of the databases Embase, Medline, Medline Express (1966-99) was performed using the keywords metformin, biguanides and lactic acidosis. All articles of cases with metformin-induced lactic acidosis (MILA) were cross-referenced. SUBJECTS: Cases were included for analysis if they met the following criteria: serum pH < or =7.35, lactate concentration > or =5 mmol L(-1). INTERVENTION: A forum of six experts in intensive care medicine independently categorized the cases in MILA unlikely (score 0), possible MILA (score 1) or probable MILA (score 2). MAIN OUTCOME MEASURES: Statistical analysis included the paired interobserver agreement (kappa) and multivariate regression analysis. RESULTS: Of 80 reported cases, 33 were excluded because of insufficient quality. The forum scores of the remaining 47 cases were distributed normally with a mean score of 7 (range 2-10). The kappa-value was 0.041 (SD = 0.24, range -0.514, 0.427). Neither lactate concentration nor mortality correlated with serum metformin concentrations. CONCLUSIONS: Given the low interobserver agreement and the lack of any relationship between metformin levels and outcome parameters, the concept that there is a simple, causal relationship between metformin use and lactic acidosis in diabetic patients has to be reconsidered. |
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Authors:
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A M E Stades; J T Heikens; D W Erkelens; F Holleman; J B L Hoekstra |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Journal of internal medicine Volume: 255 ISSN: 0954-6820 ISO Abbreviation: J. Intern. Med. Publication Date: 2004 Feb |
Date Detail:
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Created Date: 2004-01-28 Completed Date: 2004-03-01 Revised Date: 2005-11-16 |
Medline Journal Info:
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Nlm Unique ID: 8904841 Medline TA: J Intern Med Country: England |
Other Details:
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Languages: eng Pagination: 179-87 Citation Subset: IM |
Affiliation:
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Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands. amestades@yahoo.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acidosis, Lactic
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chemically induced* Adult Aged Aged, 80 and over Diabetes Mellitus, Type 2 / drug therapy Female Humans Hypoglycemic Agents / adverse effects* Male Medical Records Metformin / adverse effects* Middle Aged Regression Analysis Risk Factors |
| Chemical | |
Reg. No./Substance:
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0/Hypoglycemic Agents; 657-24-9/Metformin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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