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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with interest the article by Boada Fern&#225;ndez del Campo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on metformin-associated lactic acidosis &#40;MALA&#41;&#44; where the authors performed an excellent analysis on its association with acute renal dysfunction&#44; highlighting the creatinine levels detected in patients admitted with MALA&#46; However&#44; the authors did not analyze the previous renal dysfunction of the patients with metformin and hyperlactatemia&#44; which is clearly related to this sometimes fatal complication&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In a retrospective observational study from January 2016 to June 2018 in Hospital San Juan de Dios del Aljarafe&#44; a district hospital that treats 294&#44;000 inhabitants&#44; with a rate of metformin use of 430&#47;10&#44;000 inhabitants&#47;year&#44; we analyzed 9283 emergency episodes of patients treated with metformin &#40;10&#46;6 emergency episodes&#47;month&#47;10&#44;000 inhabitants&#41;&#46; We detected 222 cases with lactate levels &#8805;2&#46;7&#8239;mmol&#47;L&#46; In 56 cases&#44; hyperlactatemia was associated with acidosis and renal failure&#44; 17 of the which &#40;30&#37;&#41; were diagnosed with MALA &#40;5&#46;4 cases&#47;10&#44;000 patients with metformin&#47;year&#44; similar to the study by Boada Fern&#225;ndez del Campo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#41;&#46; Of these&#44; 10 were admitted to the ICU requiring dialysis&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> with an overall mortality of 53&#37;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> lists the baseline glomerular filtration rates &#40;GFR&#41; of the treated patients&#44; showing that 35&#37; of those who presented hyperlactatemia&#44; 53&#37; of those with associated renal dysfunction and acidosis&#44; and 76&#37; of those who developed MALA had previous renal dysfunction&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We observed that the incidence rate of hyperlactatemia in both studies was higher than that reported in the datasheet &#40;&#60;1&#58;10&#44;000 exposed individuals&#41; and that reported in other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Our study data also confirm that a high proportion of the patients with metformin-associated hyperlactatemia had a baseline GFR &#60;60&#8239;mL&#47;min&#47;1&#46;73&#8239;m<span class="elsevierStyleSup">2</span>&#46; Given the high associated mortality&#44; we believe that precautions need to be taken in handling metformin in patients with renal dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span>"
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Correspondence
Metformin-induced lactic acidosis: should we be more careful with renal dysfunction?
Acidosis láctica por metformina: ¿debemos ser más cautelosos con la disfunción renal?
A.L. Blanco Taboadaa,
Corresponding author
blancoanalaura.92@gmail.com

Corresponding author.
, J. Castilla Yélamosa, S. Delgado Romeroa, J.L. García Garmendiab
a Servicio de Medicina Interna, Hospital San Juan de Dios de Aljarafe, Bormujos, Sevilla, Spain
b Servicio de Cuidados Críticos y Urgencias, Hospital San Juan de Dios de Aljarafe, Bormujos, Sevilla, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with interest the article by Boada Fern&#225;ndez del Campo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on metformin-associated lactic acidosis &#40;MALA&#41;&#44; where the authors performed an excellent analysis on its association with acute renal dysfunction&#44; highlighting the creatinine levels detected in patients admitted with MALA&#46; However&#44; the authors did not analyze the previous renal dysfunction of the patients with metformin and hyperlactatemia&#44; which is clearly related to this sometimes fatal complication&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In a retrospective observational study from January 2016 to June 2018 in Hospital San Juan de Dios del Aljarafe&#44; a district hospital that treats 294&#44;000 inhabitants&#44; with a rate of metformin use of 430&#47;10&#44;000 inhabitants&#47;year&#44; we analyzed 9283 emergency episodes of patients treated with metformin &#40;10&#46;6 emergency episodes&#47;month&#47;10&#44;000 inhabitants&#41;&#46; We detected 222 cases with lactate levels &#8805;2&#46;7&#8239;mmol&#47;L&#46; In 56 cases&#44; hyperlactatemia was associated with acidosis and renal failure&#44; 17 of the which &#40;30&#37;&#41; were diagnosed with MALA &#40;5&#46;4 cases&#47;10&#44;000 patients with metformin&#47;year&#44; similar to the study by Boada Fern&#225;ndez del Campo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#41;&#46; Of these&#44; 10 were admitted to the ICU requiring dialysis&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> with an overall mortality of 53&#37;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> lists the baseline glomerular filtration rates &#40;GFR&#41; of the treated patients&#44; showing that 35&#37; of those who presented hyperlactatemia&#44; 53&#37; of those with associated renal dysfunction and acidosis&#44; and 76&#37; of those who developed MALA had previous renal dysfunction&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We observed that the incidence rate of hyperlactatemia in both studies was higher than that reported in the datasheet &#40;&#60;1&#58;10&#44;000 exposed individuals&#41; and that reported in other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Our study data also confirm that a high proportion of the patients with metformin-associated hyperlactatemia had a baseline GFR &#60;60&#8239;mL&#47;min&#47;1&#46;73&#8239;m<span class="elsevierStyleSup">2</span>&#46; Given the high associated mortality&#44; we believe that precautions need to be taken in handling metformin in patients with renal dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Blanco Taboada AL&#44; et al&#46; Acidosis l&#225;ctica por metformina&#58; &#191;debemos ser m&#225;s cautelosos con la disfunci&#243;n renal&#63; Rev Clin Esp&#46; 2020&#59;220&#58;76&#8211;76&#46;</p>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">GFR&#44; glomerular filtration rate estimated by the modification of diet in renal disease-4 formula&#59; MALA&#44; metformin-associated lactic acidosis&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients with hyperlactatemia &#40;n&#8239;&#61;&#8239;222&#41;&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Acidosis con hiperlactacidemia por metformina&#58; frecuencia de su diagn&#243;stico en la pr&#225;ctica cl&#237;nica habitual y relaci&#243;n con la insuficiencia renal"
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                            0 => "C&#46; Boada Fern&#225;ndez del Campo"
                            1 => "C&#46; Rodr&#237;guez Jim&#233;nez"
                            2 => "M&#46;M&#46; Garc&#237;a Saiz"
                            3 => "A&#46;M&#46; Aldea Perona"
                            4 => "E&#46;J&#46; Sanz &#193;lvarez"
                            5 => "E&#46; Fern&#225;ndez Quintana"
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                      "doi" => "10.1016/j.rce.2018.11.006"
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                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2019"
                        "volumen" => "219"
                        "numero" => "5"
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                        "paginaFinal" => "242"
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                      "titulo" => "Recomendaciones para el tratamiento de los pacientes cr&#237;ticos de los Grupos de Trabajo de la Sociedad Espa&#241;ola de Medicina Intensiva&#44; Cr&#237;tica y Unidades Coronarias &#40;SEMICYUC&#41;"
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                          "autores" => array:6 [
                            0 => "A&#46; Hern&#225;ndez-Tejedor"
                            1 => "O&#46; Pe&#241;uelas"
                            2 => "G&#46; Sirgo Rodr&#237;guez"
                            3 => "J&#46;A&#46; Llompart-Pou"
                            4 => "E&#46; Palencia Herrej&#243;n"
                            5 => "A&#46; Estella"
                          ]
                        ]
                      ]
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                      "doi" => "10.1016/j.medin.2017.03.004"
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                        "fecha" => "2017"
                        "volumen" => "41"
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                      "titulo" => "Metformin-associated lactic acidosis undergoing renal replacement therapy in intensive care units&#58; a five-million population-based study in the North-West of Italy"
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                  "referenciaCompleta" => "Use of metformin to treat diabetes now expanded to patients with moderately reduced kidney function&#46; Recommendations for patients with kidney impairment updated in product information&#46; European Medicines Agency&#44; Dec 2016&#59; 1-4&#46; Disponible en <a target="_blank" href="https://www.ema.europa.eu/en/documents/referral/metformin-article-31-referral-use-metformin-treat-diabetes-now-expanded-patients-moderately-reduced">https&#58;&#47;&#47;www&#46;ema&#46;europa&#46;eu&#47;en&#47;documents&#47;referral&#47;metformin-article-31-referral-use-metformin-treat-diabetes-now-expanded-patients-moderately-reduced</a>&#46;"
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Article information
ISSN: 22548874
Original language: English
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