Incidence and mortality rate of metformin associated lactic acidosis and associated factors in Diabetic patients at Chiangrai Prachanukroh Hospital
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Abstract
Introduction
Metformin is the first-line medication for treatment of type 2 DM. Although it has very few adverse event, it can cause lactic acidosis that can be fatal. We study on the incidence, mortality rates and factors associated with metformin associated lactic acidosis (MALA) for proper management in diabetic patients.
Methods
We conducted a retrospective trial in diabetic patients using metformin as antidiabetic drugs in Chiangrai Prachanukroh Hospital from 1st October 2017 to 30th September 2019 to evaluate the incidence and mortality rates of MALA and association between sex, age, serum creatinine level, metformin dosage per day, history of using angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blockers (ARB), nonsteroidal anti-inflammatory drug (NSAIDs) or diuretics and MALA.
Result
Of 6,083 cases included, 53 (0.87%) concerned MALA. 75.47% of MALA cases presented with sepsis and 71.70% turned septic shock, 90.57% had acute kidney injury. The mortality rate of MALA in this study was 11.32%. Mean age of MALA patients was 58.77 years-old, 47.17% was female. Factor associated with MALA were baseline serum creatinine, baseline eGFR, metformin dose per day, ACEI or ARB used, and NSAIDs used.
Discussion and Conclusions
To minimize MALA risk, we should use metformin with precaution if patient had serum creatinine more than 1.0 mg/dL or eGFR lower than 45 ml/min. Metformin dosage should not use more than 1,500 mg per day. NSAIDs used with metformin should be avoid.
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References
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