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At a glance: The ONWARDS insulin icodec trials

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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Letter

Metformin and lactic acidosis during shock: just the tip of the iceberg?

Authors: Rene A. Posma, Anthony R. Absalom, Daan J. Touw, Iwan C. C. van der Horst, Maarten W. N. Nijsten

Published in: Critical Care | Issue 1/2016

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Excerpt

Doenyas-Barak et al. concluded recently in Critical Care that with similar high lactate levels (>10 mmol/L) the prognosis of metformin users compared with non-users was favorable during admission to the emergency department with septic shock (in-hospital mortality, 57 % versus 88 %, P < 0.001) [1]. This observation and similar findings reported previously are suggestive of a role for metformin as a lactate generation amplifier [2, 3]. However, in this study, causality cannot be proven, since without metformin concentration measurements a dose-response analysis is not possible. …
Literature
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Doenyas-Barak K, Beberashvili I, Marcus R, Efrati S. Lactic acidosis and severe septic shock in metformin users: a cohort study. Crit Care. 2016;20:10.CrossRefPubMedPubMedCentral
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Seidowsky A, Nseir S, Houdret N, Fourrier F. Metformin-associated lactic acidosis: a prognostic and therapeutic study. Crit Care Med. 2009;37:2191–6.CrossRefPubMed
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Lalau JD, Arnouts P, Sharif A, De Broe ME. Metformin and other antidiabetic agents in renal failure patients. Kidney Int. 2015;87:308–22.CrossRefPubMed
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O’Brien RC, Adam WR. A justification for less restrictive guidelines on the use of metformin in stable chronic renal disease. Diabet Med. 2014;31:1032–8.CrossRefPubMed
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Tucker GT, Cadey C, Phillips PJ, Connor H, Ward JD, Woods HF. Metformin kinetics in healthy subjects and in patients with diabetes mellitus. Br J Clin Pharmacol. 1981;12:235–46.CrossRefPubMedPubMedCentral
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Cucchiari D, Podesta MA, Merizzoli E, Calvetta A, Morenghi E, Angelini C, et al. Dose-related effect of metformin on acid base balance and renal function in patients with diabetes who develop acute renal failure: a cross-sectional study. Acta Diabetol. 2016 Jan 28. [Epub ahead of print].
Metadata
Title
Metformin and lactic acidosis during shock: just the tip of the iceberg?
Authors
Rene A. Posma
Anthony R. Absalom
Daan J. Touw
Iwan C. C. van der Horst
Maarten W. N. Nijsten
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1333-2

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