{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T17:48:31Z","timestamp":1755798511565,"version":"3.44.0"},"reference-count":8,"publisher":"SMC Media","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0The prevalence of type 2 diabetes mellitus has surged globally. Metformin is recommended as the first-line oral treatment. However, metformin-associated lactic acidosis (MALA) is recognized as a rare but potentially dangerous complication. The pathogenesis of MALA is multifactorial, primarily resulting from the interference of metformin with mitochondrial function and hepatic gluconeogenesis, leading to lactate accumulation. Risk of MALA escalates with impaired kidney function, poorly controlled diabetes, fasting, and liver dysfunction. Case Description:\u00a0A 57-year-old woman with diabetes and hypertension presented with prolonged gastrointestinal symptoms. During this episode she continued using metformin. She had severe metabolic acidosis and acute kidney injury. Continuous venovenous hemodiafiltration was initiated, resulting in significant clinical improvement and normalized arterial blood gas parameters within 16 hours. Discussion:\u00a0The pharmacokinetic properties of metformin facilitate efficient elimination via hemodialysis and\/or hemofiltration. Continuous venovenous hemodiafiltration emerges as effective for MALA treatment. In the case described the calculated metformin clearance during continuous venovenous hemodiafiltration was notably higher than reported values, possibly due to residual renal clearance. Clinical improvement occurred despite elevated metformin levels, suggesting a lack of correlation between metformin levels and patient outcomes. Comorbidities rather than metformin levels guide treatment decisions in MALA. Conclusion:\u00a0This case underscores the efficacy of continuous venovenous hemodiafiltration in the treatment of MALA, suggesting its potential as a standard therapeutic approach. However, further research is needed\u00a0<\/jats:p>","DOI":"10.12890\/2024_004784","type":"journal-article","created":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T09:49:21Z","timestamp":1725356961000},"source":"Crossref","is-referenced-by-count":1,"title":["Effective extracorporeal treatment of metformin-associated lactic acidosis using continuous venovenous hemodiafiltration"],"prefix":"10.12890","volume":"11","author":[{"given":"M\u00e8dea","family":"Brouwer","sequence":"first","affiliation":[{"name":"Department of Pharmacology, Zuyderland MC, Heerlen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandy","family":"Offermans","sequence":"first","affiliation":[{"name":"Department of Intensive Care, Zuyderland MC, Heerlen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisanne","family":"van Nuil","sequence":"first","affiliation":[{"name":"Department of Pharmacology, Zuyderland MC, Heerlen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Astrid","family":"Poukens","sequence":"first","affiliation":[{"name":"Department of Pharmacology, Zuyderland MC, Heerlen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brigit","family":"van Oijen","sequence":"first","affiliation":[{"name":"Department of Pharmacology, Zuyderland MC, Heerlen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Dormans","sequence":"first","affiliation":[{"name":"Department of Intensive Care, Zuyderland MC, Heerlen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2024,9,3]]},"reference":[{"key":"10.12890\/2024_004784_ref1","unstructured":"<li>Zorginstituut Nederland. Het aantal gebruikers van diabetesmiddelen, 2003 - 2023 GIPdatabank.nl. gipdatabank.nl. Available from: https:\/\/www.gipdatabank.nl\/databank?infotype=g&amp;label=00-totaal&amp;tabel=B_01-basis&amp;geg=gebr&amp;item=A10BA02<\/li>"},{"key":"10.12890\/2024_004784_ref2","doi-asserted-by":"crossref","unstructured":"<li>Lalau JD, Arnouts P, Sharif A, De Broe ME. Metformin and other antidiabetic agents in renal failure patients. <em>Kidney International<\/em> 2015;<strong>87<\/strong>:308\u2013322. <\/li>","DOI":"10.1038\/ki.2014.19"},{"key":"10.12890\/2024_004784_ref3","unstructured":"<li>Dyatlova N, Tobarran NV, Kannan L, North R, Wills BK. Metformin-Associated Lactic Acidosis (MALA). Treasure Island: StatPearls Publishing;2024. <\/li>"},{"key":"10.12890\/2024_004784_ref4","doi-asserted-by":"crossref","unstructured":"<li>Kajbaf F, De Broe ME, Lalau JD. Therapeutic Concentrations of Metformin: a systematic review. <em>Clinical Pharmacokinetics<\/em>. 2015;<strong>55<\/strong>:439\u2013459. <\/li>","DOI":"10.1007\/s40262-015-0323-x"},{"key":"10.12890\/2024_004784_ref5","doi-asserted-by":"crossref","unstructured":"<li>Calello DP, Liu KD, Wiegand TJ, Roberts DM, Lavergne V, Gosselin S, et al. Extracorporeal treatment for metformin poisoning. <em>Critical Care Medicine<\/em> 2015;<strong>43<\/strong>:1716\u20131730. <\/li>","DOI":"10.1097\/CCM.0000000000001002"},{"key":"10.12890\/2024_004784_ref6","doi-asserted-by":"crossref","unstructured":"<li>Lewis B, Brooks D, Dion C, Schwebach C. Toxicokinetics of metformin overdose treated with CVVHDF. <em>The American Journal of Emergency Medicine<\/em> 2023;<strong>68<\/strong>:216.e1-216.e3.<\/li>","DOI":"10.1016\/j.ajem.2023.02.038"},{"key":"10.12890\/2024_004784_ref7","doi-asserted-by":"crossref","unstructured":"<li>Chowdhury W, Lodhi MU, Syed IA, Ahmed U, Miller M, Rahim M. Metformin-induced lactic acidosis: A case study. <em>Cureus<\/em> 2018 April;<strong>10<\/strong>:e2152. <\/li>","DOI":"10.7759\/cureus.2152"},{"key":"10.12890\/2024_004784_ref8","doi-asserted-by":"crossref","unstructured":"<li>Vordoni A, Theofilis P, Vlachopanos G, Koukoulaki M, Kalaitzidis RG. Metformin-associated lactic acidosis and acute kidney injury in the era of COVID-19. <em>Front Biosci (Schol Ed)<\/em> 2021;<strong>13<\/strong>:202.<\/li>","DOI":"10.52586\/S563"}],"container-title":["European Journal of Case Reports in Internal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/4784\/4236","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/4784\/4237","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/4784\/4237","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T10:13:59Z","timestamp":1755598439000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/view\/4784"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,3]]},"references-count":8,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.12890\/2024_004784","relation":{"has-manifestation":[{"id-type":"other","id":"1-117-4784-g4236","asserted-by":"subject"},{"id-type":"other","id":"1-117-4784-g4237","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-117","asserted-by":"subject"}]},"ISSN":["2284-2594"],"issn-type":[{"type":"electronic","value":"2284-2594"}],"subject":[],"published":{"date-parts":[[2024,9,3]]}}}