The article describing metformin-induced lactate acidosis (1)
contains a figure which might be amended for clarity.
The case is that metformin increases the D-lactate formation from the
methylglyoxal, a glucose break-down product, through the methylglyoxalase
system (2). The increase can be demonstrated even in clinically stable
diabetes patients receiving the drug.
This distinction is important as D-lactate is slowly metabolized by a
high Km mitochonrial D-lactate oxidase contributing thus to the duration
of acidosis.
Propylene glycol in IV drugs also gives rise to D-lactate so that
this could also be its source in critically ill patients.
1 Fitzgerald E, Mathieu S, Ball A. Metformin associated lactic
acidosis. BMJ 2009; 339: b3660
2 Talasniemi JP, Pennanen S, Savolainen H, et al. Assay of D-lactate
in diabetic plasma and urine. Clin Biochem 2008; 41: 1099-1103
Competing interests:
None declared
Competing interests:
27 November 2009
Heikki Savolainen
Prof.
Dept. of Occup. Safety & Hlth., POB 536, FIN-33101 Tampere, Finland
Rapid Response:
D-lactate acidosis due to metformin
Dear Editor,
The article describing metformin-induced lactate acidosis (1) contains a figure which might be amended for clarity.
The case is that metformin increases the D-lactate formation from the methylglyoxal, a glucose break-down product, through the methylglyoxalase system (2). The increase can be demonstrated even in clinically stable diabetes patients receiving the drug.
This distinction is important as D-lactate is slowly metabolized by a high Km mitochonrial D-lactate oxidase contributing thus to the duration of acidosis.
Propylene glycol in IV drugs also gives rise to D-lactate so that this could also be its source in critically ill patients.
1 Fitzgerald E, Mathieu S, Ball A. Metformin associated lactic acidosis. BMJ 2009; 339: b3660
2 Talasniemi JP, Pennanen S, Savolainen H, et al. Assay of D-lactate in diabetic plasma and urine. Clin Biochem 2008; 41: 1099-1103
Competing interests: None declared
Competing interests: