It's very difficult to spot lactic acidosis from symptoms: it has nonspecific symptoms such as fatigue (malaise), muscle aches (myalgias), difficulty breathing (respiratory distress), sleepiness (increasing somnolence), and belly aches nonspecific abdominal distress). There may be associated drop in body temperature (hypothermia), drop in blood pressure (hypotension), and when more severe, slowing of the heart rate (bradyarrhythmias). Sometimes, patients become severely ill, and are hospitalized with these findings, and it still takes a while for the diagnosis to be made.
Every patient starting metformin should be educated to the importance of these symptoms, and instructed to notify his/her physician immediately if they were to occur.
And every physician should check the creatinine level before starting metformin. There is a list of other situations where metformin should be avoided, all related to the risk of lactic acidosis: liver impairment, excessive alcohol consumption, surgery, and even getting IV "dye" (intravascular radiocontrast materials) for X-rays studies.
Metformin is a very effective drug for type 2 diabetes. And with a few precautions, the chance of metformin-associated lactic acidosis will be considerably lessened. And that's a good thing.
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