Wednesday, August 14, 2019


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.




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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