Incidence Of Metformin Induced Lactic Acidosis

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Metformin-associated Lactic Acidosis In Type 2 Diabetes Mellitus: Incidence And Presentation In Common Clinical Practice

Metformin-associated lactic acidosis in type 2 diabetes mellitus: incidence and presentation in common clinical practice Correspondence and offprint requests to: E-mail: [email protected] Search for other works by this author on: Endocrinology Service Corporaci Parc Taul Nephrology Dialysis Transplantation, Volume 23, Issue 7, 1 July 2008, Pages 24362438, Jaume Almirall, Meritxell Bricull, Jos-Miguel Gonzalez-Clemente; Metformin-associated lactic acidosis in type 2 diabetes mellitus: incidence and presentation in common clinical practice, Nephrology Dialysis Transplantation, Volume 23, Issue 7, 1 July 2008, Pages 24362438, Metformin is an oral antihyperglycaemic agent used in the treatment of type 2 diabetes mellitus. In 1998, the results of the UK Prospective Diabetes Study [ 1 ] indicated that metformin treatment is associated with a reduction in total mortality compared to other antihyperglycaemic treatments. These and other results led to its progressive widespread use. In the recent ADA-EASD consensus on management of hyperglycaemia in type 2 diabetes, metformin plus lifestyle intervention is the initial recommended therapeutic step [ 2 ]. Metformin is considered to be contra Continue reading >>

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  1. Mark Simpson

    (edit: it's worth pointing out that "Ketosis " on it's own is not a bad thing, but Diabetic ketoacidosis is. I assume this is the point of the question)
    Diabetic Ketoacidosis comes from High (hyper) Blood Sugar not Low (Hypo). They could happen together, if you had high blood sugar for too long, the Ketoacidosis happened then you over treated the high and it went low. In this case you'd have 2 separate problems. Hypoglaycemia and Ketoacidosis. Low blood sugar will make you pass out and go into a coma eventually. Ketoacidosis is very painful and horrible to be part of. But I wouldn't say they increase each others danger very much.
    (i am a diabetic, not a medical professional)


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  2. Dennis Kitainik

    I'm not a doctor, but from what I know of diabetic conditions, both of these can be dangerous, and especially if they occur together (especially since ketosis would probably indicate serious hypoglycemia).

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Metformin-associated Lactic Acidosis: Current Perspectives On Causes And Risk.

Metformin-associated lactic acidosis: Current perspectives on causes and risk. University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Elcelyx Therapeutics, Inc., San Diego, CA, USA. Elcelyx Therapeutics, Inc., San Diego, CA, USA. Electronic address: [email protected] Metabolism. 2016 Feb;65(2):20-9. doi: 10.1016/j.metabol.2015.10.014. Epub 2015 Oct 9. Although metformin has become a drug of choice for the treatment of type 2 diabetes mellitus, some patients may not receive it owing to the risk of lactic acidosis. Metformin, along with other drugs in the biguanide class, increases plasma lactate levels in a plasma concentration-dependent manner by inhibiting mitochondrial respiration predominantly in the liver. Elevated plasma metformin concentrations (as occur in individuals with renal impairment) and a secondary event or condition that further disrupts lactate production or clearance (e.g., cirrhosis, sepsis, or hypoperfusion), are typically necessary to cause metformin-associated lactic acidosis (MALA). As these secondary events may be unpredictable and the mortality rate for MALA approaches 50%, metformin has been contraindicated in moderate an Continue reading >>

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  1. NicoleAnn

    Ketones and Unrinary Tract Infection

    Is it normal when you have a high level of ketone's in your system to get a urinary tract infection? I'm kinda wondering about it, since my doctor doesn't listen to me when I say I have ketone's and he gives me antibiotics for a urinary tract infection. Any help would be greatly appreciated.

  2. MarkM

    Infections are not caused by ketones. But they are encouraged by the high blood sugar that often accompanies ketones. Bacteria love warm moist places where there are lots of nutrients. If you lower your blood sugar to the point there is no longer sugar in your urine, you will be removing one of the key attractions. And hopefully you won't get so many infections. But until this happens, you are going to have to use antibiotics ... .

  3. Kaki

    I already commented on your blog this morning regarding ketones, as an individual who has had many UTI's, women know when they have an infection, as its not possible to urinate without that burning sensation, which we do not tolerate very well and will send you immediately to your doctor for medication to resolve a UTI, you made no mention as to whether you did in fact give your doctor a urine specimen.

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Lactic Acidosis And The Relationship With Metformin Usage: Case Reports

Lactic acidosis (LA) is defined as a state of decreased systemic pH (pH <7.35) and an elevated plasma lactate concentration (>5 mmol/L). It remains the most common cause of metabolic acidosis in hospitalized patients. [1] A recent review summarized the major causes of LA and the presumed mechanisms. [2] Typically, LA is divided into disorders associated with tissue hypoxia (Cohen and Woods classification type A) and disorders in which tissue hypoxia is absent (type B). Type A LA may result from severe heart failure, sepsis, or cardiopulmonary arrest; type B can be caused by renal and hepatic failure, diabetes mellitus (DM), or drugs and toxins, including metformin, valproate, and anti-retroviral agents. [3,4] It has been reported that cardiogenic or hypovolaemic shock, severe heart failure, trauma, and sepsis are the most common causes of LA. [5] Lactate accumulation may be caused by increased production (i.e., increase glycolysis caused by hypoperfusion, hypoxaemia), decreased clearance (impaired hepatic metabolism or renal excretion), or a combination of both. [6] The exact pathophysiology of elevated lactate is likely to be the result of more than 1 condition. Many studies have Continue reading >>

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  1. Aaron1963

    Ketone Breath

    I'm sitting here at my desk with a very strong odor of acetone on my breath all day. Much more than I've ever noticed before. Previously I'd detect just a trace some mornings when first waking up. I first noticed the heavy scent yesterday, and it continued all yesterday evening, night, and all day today. I guess it's a good sign that I'm likely in ketosis. I wasn't really planning to specifically seek out ketosis until around the end of the month when I expect to reach my target weight, but perhaps now is the time to start and get my body keto adapted sooner rather than later. Anyone have any suggestions for how to deal with this keto breath? I don't normally chew gum but went out and bought some sugarfree gum to see if that helps, but can still notice the scent. I also tried mouthwash, but it seemed to only mask it briefly.
    With how strong I noticed the smell, it got me wondering about something I've often wondered about. Maybe some will think I'm crazy, but given all the dragon lore in cultures around the globe, I've thought that perhaps dragons were real at one point in our history. Not enough of them to leave behind an easy to find fossil trail to prove their existence, but still enough to cause all this folklore. And along with it the stories of fire-breathing dragons. Well, in getting this keto breath, made me wonder if dragons were in a constant state of ketosis, and had some means of generating a spark to ignite their keto breath. Wonder if the fire-breathing dragons were on a ketogenic diet, or just had a bad case of T1 diabetes. Yeah, real crazy idea. Who knows what other wild ideas I'll be coming up with under a ketone powered brain compared to a glucose powered one. I did consider using a lighter near my mouth to see if it would ignite the ketones, but that thought passed in a couple milliseconds, realizing if it did ignite them it might cause some serious damage to my exterior or interior organs.
    My energy level has picked up a notch since I noticed my keto breath. Hopefully it will continue, not only at the present level, but increase even more. Leaving in 3 days on a vacation to the States and plan to pick up a blood ketone meter and strips I ordered, so hopefully it'll confirm my suspicions and allow me to monitor my progress.

  2. Ken S

    Good idea not trying to set your breath on fire

  3. jim55

    Not everyone experiences keto breath. I never have. Dr Atkins wrote about it in his books. Lack of hunger, water loss/rapid weight loss have always been my two biggest indicaters that my body has switched. I think it will go away on it's own.

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