Wednesday, August 14, 2019

MALA

Q: Mortality from Metformin associated lactic acidosis (MALA), if occurs, is about?



Answer: 50%

Lactic acidosis from metformin, known as MALA is very rare. It is reported at the incidence of only about 4 cases per 100K patient-years. But if it occurs, mortality is around 45-50%. 


The biggest risk factor is the underlying comorbidity with liver, kidney, heart or alcohol abuse. There is no antidote for MALA but hemodialysis is considered the best treatment modality.


#toxicology

#pharmacology


References:


1. Salpeter SR, Greyber E, Pasternak GA, Salpeter EE. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev 2010; :CD002967.


2. Seidowsky A, Nseir S, Houdret N, Fourrier F. Metformin-associated lactic acidosis: a prognostic and therapeutic study. Crit Care Med 2009; 37:2191.

3. Calello DP, Liu KD, Wiegand TJ, et al. Extracorporeal Treatment for Metformin Poisoning: Systematic Review and Recommendations From the Extracorporeal Treatments in Poisoning Workgroup. Crit Care Med 2015; 43:1716.

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