Acidosis in the hospital setting – is metformin a common precipitant?

Scott, Katherine A., Martin, Jennifer H. and Inder, Warrick J. (2010) Acidosis in the hospital setting – is metformin a common precipitant?. Internal Medicine Journal, 40 5: 342-346. doi:10.1111/j.1445-5994.2009.01959.x

Author Scott, Katherine A.
Martin, Jennifer H.
Inder, Warrick J.
Title Acidosis in the hospital setting – is metformin a common precipitant?
Journal name Internal Medicine Journal   Check publisher's open access policy
ISSN 1444-0903
Publication date 2010-05
Year available 2009
Sub-type Article (original research)
DOI 10.1111/j.1445-5994.2009.01959.x
Volume 40
Issue 5
Start page 342
End page 346
Total pages 5
Editor Jeff Szer
Place of publication Australia
Publisher Wiley-Blackwell Publishing Asia
Collection year 2011
Language eng
Subject C1
9201 Clinical Health (Organs, Diseases and Abnormal Conditions)
11 Medical and Health Sciences
Formatted abstract
Introduction: Acidosis is commonly seen in the acute hospital setting, and carries a high mortality. Metformin has been associated with lactic acidosis, but it is unclear how frequently this is a cause of acidosis in hospitalized inpatients.
Aims: To explore the underlying co-morbidities and acute precipitants of acidosis in the hospital setting, including the relationship between T2DM and metformin use.
Methods: Retrospective review. Cases of acidosis were identified using the hospital discharge code for acidosis for a 3 month period October – December 2005.
Results: A total of 101 episodes of acidosis were identified, 29% had isolated respiratory acidosis, 31% had metabolic acidosis and 40% had a mixed respiratory and metabolic acidosis. There were 28 cases of confirmed lactic acidosis. Twenty nine patients had T2DM, but only 5 of the subjects with T2DM had lactic acidosis; two were on metformin. The major risk factors for development of lactic acidosis were hepatic impairment (OR 33.8, p=0.01), severe left ventricular dysfunction (OR 25.3, p=0.074) and impaired renal function (OR 9.7, p=0.09) but not metformin use.
Conclusions: Most cases of metabolic and lactic acidosis in the hospital setting occur in patients not taking metformin. Hepatic, renal and cardiac dysfunction are more important predictors for the development of acidosis.
Keyword Acidosis
Hepatic Impairment
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online March 2009

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Medicine Publications
UQ Diamantina Institute Publications
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Citation counts: TR Web of Science Citation Count  Cited 9 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 11 times in Scopus Article | Citations
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Created: Tue, 13 Apr 2010, 15:25:28 EST by Fiona Mactaggart on behalf of Medicine - Princess Alexandra Hospital