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Letters |15 July 1997

Fatal Phenformin-Associated Lactic Acidosis

Jonathan Rosand, MD; Jonathan W. Friedberg, MD; Jane M. Yang, MD

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  • Massachusetts General Hospital; Boston. MA 02114
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TO THE EDITOR:
The popularity of metformin has renewed interest in biguanide hypoglycemic agents. The association between phenformin and fatal lactic acidosis, particularly in patients with renal failure, led to the withdrawal of phenformin from the U.S. market in 1977 [1]. We describe a patient who recently died of phenformin-associated lactic acidosis.
A 64-year-old Haitian woman with diabetes, hypertension, and consequent renal insufficiency presented with profound lactic acidosis (pH, 7.15; bicarbonate level <5.0 mmol/L; lactic acid level, 54.5 mmol/L). She had been hospitalized on four previous occasions for unexplained severe lactic acidosis. After recovery from such an episode, muscle biopsy had disclosed normal structure on light and electron microscopy and normal in vitro mitochondrial enzymatic function (pyruvate dehydrogenase complex, dihydrolipoamide dehydrogenase, and electron transport chain complexes I to IV). Mitochondrial DNA contained no rearrangements or known point mutations.
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Rosand J, Friedberg JW, Yang JM. Fatal Phenformin-Associated Lactic Acidosis. Ann Intern Med. ;127:170. doi: 10.7326/0003-4819-127-2-199707150-00034

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Published: Ann Intern Med. 1997;127(2):170.

DOI: 10.7326/0003-4819-127-2-199707150-00034

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Print ISSN: 0003-4819 | Online ISSN: 1539-3704

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