LA in MALA

Q: Metformin-associated lactic acidosis (MALA) usually cause __________ degree of Lactic Acidosis (LA)? - select one

A) Mild

B) Moderate

C) Severe

Answer: C

One of the most striking features, when combined with history, is the extremely high level of LA in MALA, which is unlikely to be seen in other causes of LA. However, clinicians are required to rule out other causes through a thorough history, examination, and proper investigation.

A lactate level of >8 mmol/L is a norm in MALA and can be elevated up to >20 mmol/L.

#acid-base

#toxicology

#pharmacology

References:

1. Friesecke S, Abel P, Roser M, Felix SB, Runge S. Outcome of severe lactic acidosis associated with metformin accumulation. Crit Care. 2010;14(6):R226. doi: 10.1186/cc9376. Epub 2010 Dec 20. PMID: 21171991; PMCID: PMC3220003.

2. Malani KA, Finn A. Metformin-associated lactic acidosis: a serious complication of a common drug. BMJ Case Rep. 2024 Sep 10;17(9):e260592. doi: 10.1136/bcr-2024-260592. PMID: 39256177.

3. See KC. Metformin-associated lactic acidosis: A mini review of pathophysiology, diagnosis and management in critically ill patients. World J Diabetes. 2024 Jun 15;15(6):1178-1186. doi: 10.4239/wjd.v15.i6.1178. PMID: 38983827; PMCID: PMC11229964.