Metformin Lactic Acidosis Mechanism

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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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Popular Questions

  1. carissanbo

    I'm just wondering if there are ways to tell if you're in Ketosis without using the strips. We live in the Outback in Australia in a small town and I'm not sure I would be able to find them here. And to be honest, I really don't feel like checking. I feel that I finally found a WOE that works for me and I'm feeling great and don't want to focus too much on that aspect. So I'm wondering if there are signs to tell me.
    I'm finishing up my 3rd day of induction and to be honest, it's been pretty easy for me. I haven't really had any bad side effects and after supper I have no urges or cravings to eat anything (and no urges for carbs during the day). I have ALWAYS had a snack before bed my whole life, but I've really had no interest.
    I just want to make sure I'm doing this right. If you go to my journal you can check out my menu for today if you'd like to see what I'm eating. And I have lost a few pounds.

  2. Sinbad

    You should update your profile with your weight loss so we can share your happiness
    As for ketosis, I can tell without strips because I sometimes get an odd tinny taste in my mouth, I don't feel hungry or sluggish or headachey at all, and most convincing of all (for me) is that my pee smells almost of acetone... Sometimes it looks almost greenish too but that could be because of the supplements I'm taking (or all the green veggies I'm eating, which I never used to! )
    Of course, the best sign that you're in ketosis/lipolysis is that you're losing weight!
    Good luck with the plan!

  3. btdude

    Agreed. Metal mouth prevails. You are in the bathroom every (at least) 35.4 minutes.

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Lactic Acidosis Secondary To Metformin Overdose: A Case Report

Timbrell et al.; licensee BioMed Central Ltd.2012 Metformin is a commonly used treatment modality in type 2 diabetes mellitus, with a well documented side effect of lactic acidosis. In the intensive care setting lactate and pH levels are regularly used as a useful predictor of poor prognosis. In this article we highlight how high lactate levels are not an accurate predictor of mortality in deliberate metformin overdose. We present the case of a 70-year-old Caucasian man who took a deliberate metformin overdose of unknown quantity. He had a profound lactic acidosis at presentation with a pH of 6.93 and a lactate level of more than 20mmol/L. These figures would normally correspond with a mortality of more than 80%; however, with appropriate management this patients condition improved. We provide evidence that the decision to treat severe lactic acidosis in deliberate metformin overdose should not be based on arterial lactate and pH levels, as would be the case in other overdoses. We also demonstrate that appropriate treatment with hemodiafiltration and 8.4% sodium bicarbonate, even in patients with a very high lactate and low pH, can be successful. MetforminLactate LevelLactic Acido Continue reading >>

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  1. kisinja

    Hello there!
    My apologies for posting this without consulting the doctor first -- that's going to be first thing as soon as I get back from my summer holiday next week. However finding out you're likely a diabetic is somewhat shocking and I am trying to research as much as possible (so I can also be more knowledgeable talking with doctor).
    Well, here's what happened: 3-6 weeks ago after a hearty meal (which I sometimes indulge in as I'm slim, even skinny, and also exercise a lot) I've noticed the characteristic "fruity" smell out of my mouth which as I now know means my body is undergoing ketoacidosis. But back then I didn't care much, spent the rest of the evening and went to sleep, waking up in the morning with a terrible diarrhea. And then, a couple of days ago, exactly the same thing again -- and again after a larger meal + more sweets than normal. The smelly breath lasted for 16-20h I believe, and both times I only got diarrhea after having a sleep. Other than that -- no symptoms, didn't even feel nauseous, dizzy or weak or overly thirsty (no dry mouth either). However ketoacidosis can't be explained by low sugar levels because I ate plenty of sweets that day, so it must indeed be diabetes related. There are a couple of other things about me which matching like poor eyesight and history of arrhythmia. Could this be type 1 diabetes in progress? My parents didn't have it but now I remember wetting my bed till a fairly grown up age, could have been 8 or even 10 (I was already in school for sure).. So the genetics might have manifested themselves at a young age, and maybe only because at some point in my life I've changed my diet for good (eliminating everything wheat and concentrating on fruits although I never did quit sweets which I eat daily).
    I'm not asking any particular questions but I'd love to hear from those people who have experienced ketoacidosis, and any thoughts and comments on the case welcome as well.
    Thanks a bunch,
    /// Kis

  2. jwags

    DKA is life threatening and needs to be taken careful ASAP. Are you testing your bgs when you get these episodes? You need to get a bg meter and see a doctor today and explain to him everything you told us. You go into DKA because of a lack of insulin in your body that can't handle the buildup of glucose and clear it. Type 1's and Type 2's both can suffer DKA. It is serious, get it checked out.

  3. foxl

    I would get it investigated, for sure, but my daughter who is now 10 and extremely slender has had several episodes of KETOSIS (not ketoacidosis), and her blood sugar is quite normal. She would become sick with a cold or flu, and refuse to eat, then get the keto-breath. If you are slender, and have low muscle mass, you might have very much glycogen reserve, and once you burn through it, you use up fat, and produce ketone bodies. A very normal part of human metabolism. I am tellign you this so you are not too scared to see your doctor.
    If you had ketoacidosis you would most likely be very dehydrated and need hospitalization for hydration therapy. BUT, I myself was diagnosed in DKA, and went to work that morning -- landed in the hospital by 2 pm. So please get checked out!

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Anion gap usmle - anion gap metabolic acidosis normal anion gap metabolic acidosis

Metformin-induced Lactic Acidosis With Emphasis On The Anion Gap

Metformin-induced lactic acidosis with emphasis on the anion gap We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Proceedings (Baylor University. Medical Center) Metformin-induced lactic acidosis with emphasis on the anion gap Britton Blough, MD, Amber Moreland, MD, and Adan Mora, Jr., MD The presence of an anion gap in a diabetic patient, especially if associated with evidence of compromised renal function, should prompt clinicians to consider metformin as a contributing factor. This consideration is especially important in patients with severe anion gaps associated with lactic acidosis out of proportion to the patient's clinical presentation. Measurement of serum electrolytes and determination of acid-base status is beyond routine in today's clinical practice. The importance of recognizing and treating disturbances in normal physiology can Continue reading >>

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  1. DulceDollie

    I am trying to follow a low-carb lifestyle and need to lose about 45-50 pounds. I am aware that it can be considered unnecessary to use diet pills while following a low-carb diet, however I am considering adding a supplement to maximize my weight loss and give myself a bit of a boost. I also enjoy an occasional caffeinated drink. I know that the Atkins diet states that it is ok to consume caffeine in moderation, but it does not go into detail about its affects on ketosis. My understanding is that during ketosis, the body uses fat stores for energy. If caffeine (or other energy-giving substance) is supplying the body with energy, does that mean that the body is kicked out of ketosis/doesn't look to the body's fat stores for energy? Answers greatly appreciated, thank you!

  2. Hendrix7

    As far as I understand, no.
    Caffeine slightly improves fatty acid mobilization anyway.

  3. DulceDollie

    Thank you!!

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