ReviewJournal of nephrology2016
Metformin associated lactic acidosis (MALA): clinical profiling and management.
Review in Journal of nephrology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 57 citations in OpenAlex.
- Metformin-induced encephalopathy in a peritoneal dialysis patient: the critical role of hemodialysis in reversing lentiform fork sign: a case report.BMC neurology · 2026Article
- Controversial effects of metformin on human physiology and pathophysiology.Frontiers in pharmacology · 2026Review
- Metformin-Associated Lactic Acidosis Following Acute Overdose: Clinical Course and Conservative Management.Clinical case reports · 2025Article
- Kidney replacement therapy and mortality in metformin-associated lactic acidosis with acute kidney injury (2015-2021): a multi-year cohort study.Renal failure · 2025Article
- Non-insulin diabetes medicines: a narrative review for anaesthetists and intensivists.British journal of anaesthesia · 2025Review
- Type B Lactic Acidosis: A Very Rare but Fatal Complication of Gastrointestinal Solid Tumor.Cureus · 2024Article
- Combined lactic acidosis and ketoacidosis in a female diabetic patient with severe heart failure.Cardiovascular endocrinology & metabolism · 2023Article
- The enduring enigma of sporadic chorea: A single center case series.Tremor and other hyperkinetic movements (New York, N.Y.) · 2023Article
- Type B Lactic Acidosis in a Patient with Mantle Cell Lymphoma.Case reports in critical care · 2023Article
- Does the Same Hyperlactatemia Cut-Off in the Context of Acute Diseases Hold the Same Meaning in Diabetes Mellitus?Cureus · 2022Article
- PGC-1α inhibits the NLRP3 inflammasome via preserving mitochondrial viability to protect kidney fibrosis.Cell death & disease · 2022Article
- Recommendations for Practical Use of Metformin, a Central Pharmacological Therapy in Type 2 Diabetes.Clinical diabetes : a publication of the American Diabetes Association · 2022Article
- A Dual Electrode Biosensor for Glucose and Lactate Measurement in Normal and Prolonged Obese Mice Using Single Drop of Whole Blood.Biosensors · 2021Article
- Bilateral Ureteral Obstruction Causing Acute Kidney Injury and Resultant Metformin Toxicity.Cureus · 2021Article
- Metformin, chronic nephropathy and lactic acidosis: a multi-faceted issue for the nephrologist.Journal of nephrology · 2021Review
- Identifying patients with metformin associated lactic acidosis in the emergency department.International journal of clinical pharmacy · 2020Article
- Extracorporeal treatment of metforminassociated lactic acidosis in clinical practice: a retrospective cohort study.European journal of clinical pharmacology · 2020Article
- Management of Diabetes in Patients Undergoing Bariatric Surgery.Current diabetes reports · 2019Review
- Nephrology Consultation for Severe SGLT2 Inhibitor-Induced Ketoacidosis in Type 2 Diabetes: Case Report.Medicina (Kaunas, Lithuania) · 2019Article
- Sustained low-efficiency dialysis for metformin-associated lactic acidosis in patients with acute kidney injury.Journal of nephrology · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Metformin (MF) accumulation during acute kidney injury is associated with high anion gap lactic acidosis type B (MF-associated lactic acidosis, MALA), a serious medical condition leading to high mortality. Despite dose adjustment for renal failure, diabetic patients with chronic kidney disease (CKD) stage III-IV are at risk for rapid decline in renal function by whatever reason, so that MF toxicity might arise if the drug is not timely withdrawn. Sixteen consecutive patients were admitted to our Hospital's Emergency Department with clinical findings consistent with MALA. Fifteen had prior history of CKD, 60 % of them with GFR between 30 and 60 ml/min. Of these, 5 required mechanical ventilation and cardiovascular support; 3 promptly recovered renal function after rehydration, whereas 10 (62 %) required continuous veno-venous renal replacement treatment. SOFA and SAPS II scores were significantly related to the degree of lactic acidosis. In addition, lactate levels were relevant to therapeutic choices, since they were higher in dialyzed patients than in those on conservative treatment (11.92 mmol/l vs 5.7 mmol/l, p = 0.03). The overall death rate has been 31 %, with poorer prognosis for worse acidemia, as serum pH was significantly lower in non-survivors (pH 6.96 vs 7.16, p > 0.04). Our own data and a review of the literature suggest that aged, hemodynamically frail patients, with several comorbidities and CKD, are at greater risk of MALA, despite MF dosage adjustment. Moreover, renal replacement therapy rather than simple acidosis correction by administration of alkali seems the treatment of choice, based on eventual renal recovery and overall outcome.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.