[e-drug] Metformin and Lactic acidosis (5)

["Nuru Mgori" <kaddumgori@yahoo.co.uk>]

E-DRUG: Metformin and Lactic acidosis (5)
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It is true beyond all reasonable doubt that metformin per se can cause lactic acidosis ( metformin associated lactic acidosis-MALA), but the effect is more pronounced when there are concomitant risk factors, renal insufficiency, pre-existing cardiovascular disease, congestive cardiac failure, chronic pulmonary diseases, sepsis, old age > 80 years, HIV patient on stavudine-. in absence of risk factors MALA is extremely rare.

  A study conducted by RI Misbin et al U.S.A Lactic Acidosis in Patients with Diabetes Treated with Metformin Correspondence from The New England Journal of Medicine -Volume 338:265, January 22, 1998 Number 4- Lactic Acidosis in Patients with Diabetes Treated with Metformin. revealed among 66 diabetic patients who were using metformin,  47 of them were confirmed to develop lactic acidosis by measuring the circulating lactate values >5 mmol/l as a criteria.
Among this 43 of them had risk one or more of the risk factor to develop  lactic acidosis, and only four of them didn?t have risk factor however they were recovered completely.
   
To my  view I think it will be better for the benefit of the patient if all who are diabetics and in need of metformin as their drug of choice, should be thoroughly examined and investigated so they are not at a risk of developing MALA.

As we health workers practising in third world countries around the globe, diagnostic tools are among resource limited material that are unavailable in most of the areas leaving clinical judgement as a sole element for diagnosis,  therefore the better way is by increase our level of awareness of MALA by avoiding prescribing metformin in patients suspecting to have risks factor.
   
However it is said that the development of MALA is also rare as a study done by N.N Chan et al  conducted at Diabetic unit, Medicine Directorate and section of clinical pharmacology, Imperial College School of Medicine, Chelsea & Westminster hosp, London 1999- metformin associated lactic acidosis; a rare or very rare clinical entity?
The result came out that it is a very rare clinical entity being 20 times less than phenformin associated lactic aciodisis, actually the prevalence is as low as prevalence of sulphonyurease in causing hypoglycaemia.

In my little experience I have come across a lot of patient who are using metformin, but none of them have symptomatic features of lactic acidosis, anyone around the country can give out his practical experience concerning MALA, lets share.
   
  DR NURU KADDU MGORI
  WEILL-BUGANDO MEDICAL
  CENTRE
  P.O. BOX 1370
  MWANZA 
  TANZANIA
  Internal medicine department
  0784 390595 
Nuru Mgori <kaddumgori@yahoo.co.uk>