Metformin Associated Lactic Acidosis
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Abstract
Metformin is recommended as the first-line treatment for type 2 diabetes mellitus and its use is widespread all over the world. The drug can be prescribed as a single agent or in combination with other glucose lowering medications. The use of metformin is associated with a reduction in the risk of death from cardiovascular disease. Gastrointestinal symptoms are the most frequent side effect. Metformin-associated lactic acidosis (MALA) is a less common but life-threatening complication of metformin. MALA is caused by an accumulation of metformin and lactic acid in the body as a result of reduced renal excretion. Prompt diagnosis and management are required to reduce adverse patient outcomes. The management includes close monitoring, correction of electrolytes and acid-base disturbances, treatment of other comorbid conditions and, in severe cases, removal of metformin from the body by hemodialysis. Prevention can be achieved through risk assessment prior to prescribing the medication and adjustment of the dosage in patients with reduced kidney function. The patients should be advised to stop taking the medication when suspicious symptoms of MALA occur and promptly seek medical attention.
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