ACIDOSE LÁCTICA ASSOCIADA À METFORMINA – A HEMODIÁLISE ESTÁ INDICADA? | METFORMIN ASSOCIATED LACTIC ACIDOSIS – IS HEMODIALYSIS RECOMMENDED?
Resumo
PT | RESUMO
A metformina é uma biguanida oral universalmente utilizada no tratamento da diabetes mellitus tipo 2. A sua depuração
é maioritariamente renal e por isso deve ser usada com precaução nos doentes com doença renal. Elevadas concentrações
plasmáticas de metformina podem levar a acidose láctica grave. A acidose láctica associada à metformina (MALA) é uma
condição rara, mas potencialmente fatal. Como a metformina é altamente hidrossolúvel, pode ser removida por hemodiá-
lise, idealmente prolongada, para permitir a mobilização da forma intracelular. Da revisão da literatura, constatou-se que a
hemodiálise é mais eficaz que o tratamento de suporte em doentes com MALA. No entanto, estudos maiores são necessários
para reafirmar o benefício da diálise neste contexto.
Apresentamos o caso de um doente diabético com 70 anos de idade, em choque séptico e acidémia láctica grave, em que
apenas se observou correcção da acidose metabólica após a realização de técnica de substituição renal contínua.
Palavras-chave: Metformina; Acidose láctica; Hemodiálise; Diálise renal
EN | ABSTRACT
Metformin is an oral biguanide used worldwide in the treatment of diabetes mellitus type 2. As it is renally cleared it should be used
with caution in patients with renal impairment. Elevated plasma metformin concentrations, may lead to severe lactic acidosis. Metformin-
associated lactic acidosis (MALA) is a rare but potentially life-threatening condition. As metformin is highly water soluble, it can be removed
by hemodialysis if dialysis is conducted for long enough to mobilize the intracellular form. A literature review, found that dialysis techniques
proved to be better than supportive care, in MALA patients. Larger studies are needed to draw firmer recommendations on the treatment of
MALA, especially concerning the possible beneficial effects of dialysis in this context.
We report on a 70-year-old male type 2 diabetic patient, who presented with septic shock and severe lactic acidemia, in which metabolic
acidosis was only corrected after performing continuous renal replacement therapy.
Keywords: Metformin; Lactic acidosis; Hemodialysis; Renal dialyses
Texto Completo:
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