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[Metformin associated lactic acidosis--case reports and literature review].

BACKGROUND
The use of metformin in the treatment of diabetes mellitus type II is increasing. The drug has several advantageous metabolic effects, and is considered safe if not used in the presence of contraindications, in particular renal failure.


MATERIAL AND METHODS
We present a patient with metformin associated lactic acidosis, to remind of a potentially lethal adverse reaction. We also review the literature about incidence and risk, prognosis and treatment of the disease.


RESULTS
Our patient was a 72 year old woman with diabetes mellitus type II treated with metformin, who presented with acute renal failure, severe metabolic acidosis and circulatory failure. Treatment with bicarbonate buffer and vasopressors did not improve her condition, only after hemodialysis was her situation stabilised.


INTERPRETATION
Metformin associated lactic acidosis must be considered in obscure metabolic acidosis in diabetic patients. The single most important therapeutic approach appears to be immediate hemodialysis.