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International Journal of Endocrinology
Volume 2014, Article ID 717198, 4 pages
Research Article

Interpreting the Consequences of Metformin Accumulation in an Emergency Context: Impact of the Time Frame on the Blood Metformin Levels

1Service d’Endocrinologie-Nutrition, Hôpital Sud, 80054 Amiens, France
2INSERM U-1088, Université de Picardie Jules Verne, 80037 Amiens, France

Received 7 October 2014; Accepted 22 November 2014; Published 17 December 2014

Academic Editor: Mario Maggi

Copyright © 2014 Jean-Daniel Lalau and Farshad Kajbaf. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. To clarify the link between metformin accumulation and its metabolic consequences by taking the time frame for metformin measurement into account. Research Design and Methods. Our database was studied for cases of metformin accumulation and lactic acidosis status available on admission, and then we selected patients in whom arterial pH, blood lactate, and plasma and erythrocyte metformin levels had been determined at the same time point. Results. Seventeen reports were studied on 16 patients, of whom 10 presented lactic acidosis. The time interval between admission and comprehensive testing ranged from 0 to 52 hours. The study parameters were determined simultaneously on admission in only 4 patients. In the 9 patients with lactic acidosis on admission and a delayed metformin assay, lactic acidosis persisted in 6 cases and had resolved in 3 cases by the time the blood sampling for metformin assay was performed. Conversely, lactic acidosis developed after admission in one case. Conclusions. Caution must be taken when interpreting the consequences of metformin accumulation in an emergency context: the patient’s lactic acidosis status will have changed by the time the metformin assay is performed, even though metformin accumulation may still be present.