Is Metformin Contraindicated In Congestive Heart Failure?

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Metformin Use In Patients With Diabetes And Heart Failure: Cause For Concern?

Patients with type 2 diabetes are 2.5 times more likely to develop heart failure than those without diabetes,1 and > 30% of patients with heart failure have concurrent diabetes.2 Biguanides, namely phenformin and metformin, have been used for the treatment of diabetes for decades. In certain clinical situations, however, the use of biguanides can result in an accumulation of lactic acid, which may result in a rare condition known as acute lactic acidosis (ALA), which is fatal in ∼ 50% of cases.3,4 In most instances, the development of ALA arises secondary to conditions predisposing patients to hemodynamic compromise and overt tissue hypoxia, such as acute myocardial infarction (MI), acute uncompromised heart failure, or sepsis.5,6 Phenformin was removed from the market in 1976 because of reports of both fatal and nonfatal phenformin-associated lactic acidosis (PALA).7 The incidence of PALA at the time was estimated to be between 40 and 64 cases per 100,000 patient-years, or four to six times that seen in patients with diabetes who were not on phenformin.8,9 Unlike phenformin, which is metabolized through the liver via hydroxylation, metformin is excreted unchanged in the urine.10 Continue reading >>

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Popular Questions

  1. NYC-Hot-Stuff

    Bad breath as a sign of ketosis

    The item is from WebMD.com. I hadn't heard of bad breath as a possible sign of overdoing a low-carb diet and ketosis. Is the breath connection commonly known?
    "This can make your breath stinky:
    "Correct! You answered: A very low-carb diet
    "If you eat too few carbs, your body may have to burn fat for energy, and that creates acidic chemicals called ketones. These can make your breath smell fruity or like nail-polish remover. This is called ketosis, and it can become dangerous if too many ketones build up in your body."

  2. Cathy H.

    I learned about it back when Atkins Diet was all the rage, they talked about it a lot.

  3. Sai F.

    It's common, at least with all the people I know who have been following a low carb diet. It's because of acetone that is in both your urine (urinary acetoacetate) and breath, but it does go away after awhile. Thank goodness it's not permanent.

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