![]() The incidence of metformin-associated lactic acidosis was 12.8% in a review of poison control center inquiries from Germany. Lactic acidosis has been observed in 1.6% of metformin exposures reported to poison control centers nevertheless, merely 10% of these exposures were due to deliberate overdoses. In overdose situations, lactic acidosis is seen much more habitually, even though the precise incidence is unclear. 0.03 cases of lactic acidosis per 1000 patient-years occur within therapeutic dosing, with a majority of these cases among patients that have contraindications to metformin (such as renal insufficiency). It can occur either with therapeutic metformin dosing (which is rare) or in overdose situations. Lactic acidosis can be defined as metabolic acidosis with a blood pH of less than 7.35 and serum lactate of more than 2 mmol per liter. Case reports and small case series of serious toxicity from metformin overdosage can be found in the medical literature, often with the portrayal of extracorporeal methods for the management of the subsequent severe lactic acidosis. Overdoses with metformin are rare but may result in serious consequences. Despite a good safety profile in a majority of patients with diabetes, the risk of metformin-associated lactic acidosis is genuine when safety guidelines are ignored. Metformin is now also used to treat polycystic ovary syndrome and some malignancies. Metformin is a biguanide used to treat type 2 diabetes mellitus and most commonly prescribed oral hypoglycemic agent.
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