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Metformin-induced lactic acidosis: a case series

Joana Silvestre email, Susana Carvalho email, Vitor Mendes email, Luis Coelho email, Camila Tapadinhas email, Pedro Ferreira email, Pedro Povoa email and Fatima Ceia email

Journal of Medical Case Reports 2007, 1:126doi:10.1186/1752-1947-1-126

Diabetic acidosis due to D-lactate

Heikki Savolainen   (30 July 2008)  Dept. of Occup. Safety & Hlth., POB 535, Tampere, FIN-33101, Finland email

Lactic acidosis is very common in diabetes and probably caused by methylglyoxal from excessive glucose metabolized in the glyoxalase system to d-lactic acid (1). Metformin seems to increase the d-lactic acid formation.

D-lactate causes a neurotoxic syndrome by an unknown mechanism. The long metabolic half-life of the acid may contribute to this as its oxidation by the high Km mitochondrial D-lactate oxidase is slow.

1 Talasniemi JP, Pennanen S, Savolainen H, et al. Analytical investigation: Assay of D-lactate in diabetic plasma and urine. Clin Biochem (2008), doi:10.1016/j.clinbiochem.2008.06.011

Competing interests

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