PS-042 For better iatrogenic lactic acidosis prevention: let’s manage its risk factors better!

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Abstract

Background

Adverse drug events (ADE) represent up to 27% of intensive care unit (ICU) admissions and 28% of deaths, whereas they could be prevented in 86% of cases. Metformin associated lactic acidosis (MALA) is rare (<10 per 100 000 patients per year) but represents a common cause of hospitalisation in the ICU. It is therefore necessary to study and evaluate this ADE to know its main risk factors and avoid it.

Purpose

The main objective of our study was to identify the main risk factors of MALA responsible for hospitalisation in the intensive care unit.

Material and methods

This was a 20 month prospective study, including all ICU patients admitted for MALA. We recovered hospitalisation reports before pharmaceutically analysing each clinical case.

Results

21 cases were studied for MALA for an average age of 69 years (55–87) and an average IGSII score of 52 (25–87). This ADE was avoidable in 76.2% of cases. On average, patients were hospitalised 7 days (1–15) in the ICU and 14 days post-ICU (0–44). 2 patients (9.5%) died during their stay. 1 patient was lost to follow-up. 5 patients died after their hospital discharge for an average time of follow-up of 10.7 months (1–22). 2 patients maintained renal functional impairment. Regarding the main risk factors, 71.4% of patients were dehydrated by diarrhoea and/or vomiting leading to the nephrotoxicity of their continuous associated treatments, acute kidney injury (AKI) and MALA. The other cases were due to urinary obstructions, liver failure, sepsis and cardiogenic shock. 90.5% of patients had potentially nephrotoxic treatments.

Conclusion

Hospitalisations for MALA are still too frequent despite the fact that it is avoidable in most cases. Dehydration, continuation of nephrotoxic treatment and AKI remain the main risk factors. Consequently, it is necessary to continue and develop prevention strategies to prevent their appearance, to limit their consequences and to reduce their recurrences. In our department, we will electronically send this information to general practitioners in order to make their diabetic patients more aware of the precautions with this type of treatment.

References and/or acknowledgements

DeFronzo R, Fleming GA, Chen K, et al. Metformin-associated lactic acidosis: Current perspectives on causes and risk. Metabolism2016;65:20–9.

References and/or acknowledgements

No conflict of interest

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