Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 2020
Mortality and Renal Prognosis in Isolated Metformin-Associated Lactic Acidosis Treated with Continuous Renal Replacement Therapy and Citrate-Calcium-Anticoagulation.
Use of metformin increases plasma lactate concentration and may lead to metformin-associated lactic acidosis (MALA). Previous studies have suggested severe MALA to have a mortality of 17%-21%, but have included patients with other coincident conditions such as sepsis. The treatment of choice is continuous renal replacement therapy (CRRT), which has been performed using heparin analogues or no anticoagulation in former studies. ⋯ MALA can be treated effectively and safely with CRRT and citrate-calcium-anticoagulation, usually required for 2-3 days. Mortality of patients with MALA treated with CRRT is low when other conditions inducing lactic acidosis are excluded. MALA episode may be associated with long-lasting kidney injury.