Lactic acidosis is a rare but severe and life threatening side effect of metformin. As long as contraindications to its use are kept in mind, metformin can be prescribed safely. If a patient develops one of these contraindications while on metformin therapy (e.g. renal insufficiency), metformin therapy should be discontinued temporarily, because the likelihood of developing metformin-induced lactic acidosis is then significantly increased. In metformin-induced lactic acidosis renal replacement therapy is an effective treatment option, because it eliminates metformin from the circulation and corrects the acidosis. In renal insufficiency it is important to continue dialysis despite normalized plasma metformin levels, to finally eliminate metformin that is stored in the deep tissue compartments.
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