T Case Re Port Metformin-associated Lac Tic Ac I Do Sis and Acute Re Nal Fail Ure in a Type 2 Di a Betic Pa Tient

and metformin (dimethylbiguanide), have been linked to lac tic ac i do sis (LA), a met a bolic con di tion as so ci ated with high rate of mor tal ity. Phenformin was dis con tin ued in the United States (U.S.) in 1976 due to sus pected as so ci a tion with LA. Metformin, a mod i fied biguanide, has been widely used out side the U.S., with con sid er ably fewer re ported cases of LA than were re ported with phenformin. Con cern about LA, how ever, de layed the in tro duc tion of metformin into the U.S. un til May, 1995. The in ci dence of LA with metformin ther apy for type 2 di a be tes mellitus (DM) has been re ported to be 10to 20-fold lower than with phenformin, in the range of 0-0.084 cases/1,000 pa tient-year. The over all mor tal ity rate of metformin-associated lac tic ac i do sis (MALA) is es ti mated to be about 30 to 50%. Al though LA can oc cur with metformin, the risk is low if the drug is pre scribed to pa tients who do not have im paired hepatic, re nal or cardiopulmonary func tion.