Lactic acidosis: relationship between metformin levels, lactate concentration and mortality
Aim The role of metformin in lactic acidosis is regularly questioned. Arguments against a causal role for metformin in lactic acidosis occurrence are the lack of correlation between plasma metformin and lactate levels, as well as between metformin plasma levels and mortality. We aim to analyse these...
Gespeichert in:
| Veröffentlicht in: | Diabetic medicine 2016-11, Vol.33 (11), p.1536-1543 |
|---|---|
| Hauptverfasser: | , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1543 |
|---|---|
| container_issue | 11 |
| container_start_page | 1536 |
| container_title | Diabetic medicine |
| container_volume | 33 |
| creator | Boucaud-Maitre, D. Ropers, J. Porokhov, B. Altman, J.-J. Bouhanick, B. Doucet, J. Girardin, E. Kaloustian, E. Lassmann Vague, V. Emmerich, J. |
| description | Aim
The role of metformin in lactic acidosis is regularly questioned. Arguments against a causal role for metformin in lactic acidosis occurrence are the lack of correlation between plasma metformin and lactate levels, as well as between metformin plasma levels and mortality. We aim to analyse these correlations in a large series of lactic acidosis cases recorded in the French nationwide pharmacovigilance database.
Methods
All cases of lactic acidosis spontaneously reported between 1985 and October 2013 associated with metformin exposure were extracted from the pharmacovigilance database. We assessed the statistical correlations between prescribed daily doses of metformin, plasma concentrations of metformin and lactate, pH and plasma creatinine, as well as the relationship between mortality and these variables.
Results
Seven hundred and twenty‐seven cases of lactic acidosis were reported during the period. Metformin plasma concentration was documented for 260 patients, lactate plasma concentration for 556 patients, pH for 502 patients, creatinine for 397 patients and the vital outcome for 713 patients. Metformin plasma concentration, lactate concentration, pH and plasma creatinine were all correlated (P < 0.001). There were significant differences between surviving and deceased patients in terms of metformin plasma levels (25.2 vs. 37.4 mg/l, P = 0.002) and lactate concentrations (10.8 vs. 16.3 mmol/l, P < 0.001). Thirty per cent of patients died when metformin concentration was > 5 mg/l compared with 11% for patients with concentration < 5 mg/l (P = 0.003).
Conclusions
Our data suggest that metformin accumulation contributes to the pathogenesis and prognosis of lactic acidosis.
What's new?
This paper examines the correlations observed between metformin, lactate plasma and mortality in the largest case series of lactic acidosis available (n = 727).
Significant differences are observed between surviving and deceased patients in terms of metformin plasma levels (25.2 vs. 37.4 mg/l, P = 0.002) and lactate concentrations (10.8 vs. 16.3 mmol/l, P < 0.001).
These findings contradict other publications on this matter and suggest that metformin accumulation might contribute to the pathogenesis and prognosis of lactic acidosis. |
| doi_str_mv | 10.1111/dme.13098 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_02473379v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1826649999</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5248-1d612cd18454dc47e2bf6c9a01bf8a1f6335aad28aaa688feec3b8ccc74a756e3</originalsourceid><addsrcrecordid>eNqNkc1rVDEUxYModqwu_AfkgRsFX5uvlw93pbZTYdSN0oWLkMm7j6bmvYxJpnX-ezOddgRB8G4uXH7ncC4HoZcEH5E6x_0IR4RhrR6hGeGCtx3X5DGaYclpy7AkB-hZztcYE6qZfooOqFCKYk1n6PvCuuJdY53vY_b5fZMg2OLjlK_8qllCuQWYmhHKENPopybADYT8rglVZws0Lk4OppLuNI2d-maMqdjgy-Y5ejLYkOHF_T5E387Pvp5etIsv84-nJ4vWdZSrlvSCUNcTxTveOy6BLgfhtMVkOShLBsFYZ21PlbW25h4AHFsq55zkVnYC2CF6u_O9ssGskh9t2phovbk4WZjtDVMuGZP6hlT2zY5dpfhzDbmY0WcHIdgJ4jobophknCjS_QdKheC6TkVf_4Vex3Wa6tNbSne404z-yelSzDnBsA9LsNkWaWqR5q7Iyr66d1wvR-j35ENzFTjeAbc-wObfTubDp7MHy3an8LnAr73Cph9GSCY7c_l5bsglmwvNz41ivwEZmLXH</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1829505932</pqid></control><display><type>article</type><title>Lactic acidosis: relationship between metformin levels, lactate concentration and mortality</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Boucaud-Maitre, D. ; Ropers, J. ; Porokhov, B. ; Altman, J.-J. ; Bouhanick, B. ; Doucet, J. ; Girardin, E. ; Kaloustian, E. ; Lassmann Vague, V. ; Emmerich, J.</creator><creatorcontrib>Boucaud-Maitre, D. ; Ropers, J. ; Porokhov, B. ; Altman, J.-J. ; Bouhanick, B. ; Doucet, J. ; Girardin, E. ; Kaloustian, E. ; Lassmann Vague, V. ; Emmerich, J.</creatorcontrib><description>Aim
The role of metformin in lactic acidosis is regularly questioned. Arguments against a causal role for metformin in lactic acidosis occurrence are the lack of correlation between plasma metformin and lactate levels, as well as between metformin plasma levels and mortality. We aim to analyse these correlations in a large series of lactic acidosis cases recorded in the French nationwide pharmacovigilance database.
Methods
All cases of lactic acidosis spontaneously reported between 1985 and October 2013 associated with metformin exposure were extracted from the pharmacovigilance database. We assessed the statistical correlations between prescribed daily doses of metformin, plasma concentrations of metformin and lactate, pH and plasma creatinine, as well as the relationship between mortality and these variables.
Results
Seven hundred and twenty‐seven cases of lactic acidosis were reported during the period. Metformin plasma concentration was documented for 260 patients, lactate plasma concentration for 556 patients, pH for 502 patients, creatinine for 397 patients and the vital outcome for 713 patients. Metformin plasma concentration, lactate concentration, pH and plasma creatinine were all correlated (P < 0.001). There were significant differences between surviving and deceased patients in terms of metformin plasma levels (25.2 vs. 37.4 mg/l, P = 0.002) and lactate concentrations (10.8 vs. 16.3 mmol/l, P < 0.001). Thirty per cent of patients died when metformin concentration was > 5 mg/l compared with 11% for patients with concentration < 5 mg/l (P = 0.003).
Conclusions
Our data suggest that metformin accumulation contributes to the pathogenesis and prognosis of lactic acidosis.
What's new?
This paper examines the correlations observed between metformin, lactate plasma and mortality in the largest case series of lactic acidosis available (n = 727).
Significant differences are observed between surviving and deceased patients in terms of metformin plasma levels (25.2 vs. 37.4 mg/l, P = 0.002) and lactate concentrations (10.8 vs. 16.3 mmol/l, P < 0.001).
These findings contradict other publications on this matter and suggest that metformin accumulation might contribute to the pathogenesis and prognosis of lactic acidosis.</description><identifier>ISSN: 0742-3071</identifier><identifier>EISSN: 1464-5491</identifier><identifier>DOI: 10.1111/dme.13098</identifier><identifier>PMID: 26882092</identifier><identifier>CODEN: DIMEEV</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Acidosis, Lactic - blood ; Acidosis, Lactic - chemically induced ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antiretroviral drugs ; Cardiology and cardiovascular system ; Diabetes ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes Mellitus, Type 2 - mortality ; Endocrinology and metabolism ; Female ; Geriatry and gerontology ; Human health and pathology ; Humans ; Hydrogen-Ion Concentration ; Lactic Acid - blood ; Life Sciences ; Male ; Metformin - administration & dosage ; Metformin - adverse effects ; Metformin - blood ; Methodology ; Middle Aged ; Mortality ; Pathogenesis ; Pharmacovigilance ; Plasma ; Prognosis ; Statistics ; Survival Analysis ; Young Adult</subject><ispartof>Diabetic medicine, 2016-11, Vol.33 (11), p.1536-1543</ispartof><rights>2016 Diabetes UK</rights><rights>2016 Diabetes UK.</rights><rights>Diabetic Medicine © 2016 Diabetes UK</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5248-1d612cd18454dc47e2bf6c9a01bf8a1f6335aad28aaa688feec3b8ccc74a756e3</citedby><cites>FETCH-LOGICAL-c5248-1d612cd18454dc47e2bf6c9a01bf8a1f6335aad28aaa688feec3b8ccc74a756e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdme.13098$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdme.13098$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26882092$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.univ-antilles.fr/hal-02473379$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Boucaud-Maitre, D.</creatorcontrib><creatorcontrib>Ropers, J.</creatorcontrib><creatorcontrib>Porokhov, B.</creatorcontrib><creatorcontrib>Altman, J.-J.</creatorcontrib><creatorcontrib>Bouhanick, B.</creatorcontrib><creatorcontrib>Doucet, J.</creatorcontrib><creatorcontrib>Girardin, E.</creatorcontrib><creatorcontrib>Kaloustian, E.</creatorcontrib><creatorcontrib>Lassmann Vague, V.</creatorcontrib><creatorcontrib>Emmerich, J.</creatorcontrib><title>Lactic acidosis: relationship between metformin levels, lactate concentration and mortality</title><title>Diabetic medicine</title><addtitle>Diabet. Med</addtitle><description>Aim
The role of metformin in lactic acidosis is regularly questioned. Arguments against a causal role for metformin in lactic acidosis occurrence are the lack of correlation between plasma metformin and lactate levels, as well as between metformin plasma levels and mortality. We aim to analyse these correlations in a large series of lactic acidosis cases recorded in the French nationwide pharmacovigilance database.
Methods
All cases of lactic acidosis spontaneously reported between 1985 and October 2013 associated with metformin exposure were extracted from the pharmacovigilance database. We assessed the statistical correlations between prescribed daily doses of metformin, plasma concentrations of metformin and lactate, pH and plasma creatinine, as well as the relationship between mortality and these variables.
Results
Seven hundred and twenty‐seven cases of lactic acidosis were reported during the period. Metformin plasma concentration was documented for 260 patients, lactate plasma concentration for 556 patients, pH for 502 patients, creatinine for 397 patients and the vital outcome for 713 patients. Metformin plasma concentration, lactate concentration, pH and plasma creatinine were all correlated (P < 0.001). There were significant differences between surviving and deceased patients in terms of metformin plasma levels (25.2 vs. 37.4 mg/l, P = 0.002) and lactate concentrations (10.8 vs. 16.3 mmol/l, P < 0.001). Thirty per cent of patients died when metformin concentration was > 5 mg/l compared with 11% for patients with concentration < 5 mg/l (P = 0.003).
Conclusions
Our data suggest that metformin accumulation contributes to the pathogenesis and prognosis of lactic acidosis.
What's new?
This paper examines the correlations observed between metformin, lactate plasma and mortality in the largest case series of lactic acidosis available (n = 727).
Significant differences are observed between surviving and deceased patients in terms of metformin plasma levels (25.2 vs. 37.4 mg/l, P = 0.002) and lactate concentrations (10.8 vs. 16.3 mmol/l, P < 0.001).
These findings contradict other publications on this matter and suggest that metformin accumulation might contribute to the pathogenesis and prognosis of lactic acidosis.</description><subject>Acidosis, Lactic - blood</subject><subject>Acidosis, Lactic - chemically induced</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antiretroviral drugs</subject><subject>Cardiology and cardiovascular system</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 2 - blood</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Diabetes Mellitus, Type 2 - mortality</subject><subject>Endocrinology and metabolism</subject><subject>Female</subject><subject>Geriatry and gerontology</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Hydrogen-Ion Concentration</subject><subject>Lactic Acid - blood</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Metformin - administration & dosage</subject><subject>Metformin - adverse effects</subject><subject>Metformin - blood</subject><subject>Methodology</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Pathogenesis</subject><subject>Pharmacovigilance</subject><subject>Plasma</subject><subject>Prognosis</subject><subject>Statistics</subject><subject>Survival Analysis</subject><subject>Young Adult</subject><issn>0742-3071</issn><issn>1464-5491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkc1rVDEUxYModqwu_AfkgRsFX5uvlw93pbZTYdSN0oWLkMm7j6bmvYxJpnX-ezOddgRB8G4uXH7ncC4HoZcEH5E6x_0IR4RhrR6hGeGCtx3X5DGaYclpy7AkB-hZztcYE6qZfooOqFCKYk1n6PvCuuJdY53vY_b5fZMg2OLjlK_8qllCuQWYmhHKENPopybADYT8rglVZws0Lk4OppLuNI2d-maMqdjgy-Y5ejLYkOHF_T5E387Pvp5etIsv84-nJ4vWdZSrlvSCUNcTxTveOy6BLgfhtMVkOShLBsFYZ21PlbW25h4AHFsq55zkVnYC2CF6u_O9ssGskh9t2phovbk4WZjtDVMuGZP6hlT2zY5dpfhzDbmY0WcHIdgJ4jobophknCjS_QdKheC6TkVf_4Vex3Wa6tNbSne404z-yelSzDnBsA9LsNkWaWqR5q7Iyr66d1wvR-j35ENzFTjeAbc-wObfTubDp7MHy3an8LnAr73Cph9GSCY7c_l5bsglmwvNz41ivwEZmLXH</recordid><startdate>201611</startdate><enddate>201611</enddate><creator>Boucaud-Maitre, D.</creator><creator>Ropers, J.</creator><creator>Porokhov, B.</creator><creator>Altman, J.-J.</creator><creator>Bouhanick, B.</creator><creator>Doucet, J.</creator><creator>Girardin, E.</creator><creator>Kaloustian, E.</creator><creator>Lassmann Vague, V.</creator><creator>Emmerich, J.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><general>Wiley</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><scope>1XC</scope></search><sort><creationdate>201611</creationdate><title>Lactic acidosis: relationship between metformin levels, lactate concentration and mortality</title><author>Boucaud-Maitre, D. ; Ropers, J. ; Porokhov, B. ; Altman, J.-J. ; Bouhanick, B. ; Doucet, J. ; Girardin, E. ; Kaloustian, E. ; Lassmann Vague, V. ; Emmerich, J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5248-1d612cd18454dc47e2bf6c9a01bf8a1f6335aad28aaa688feec3b8ccc74a756e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Acidosis, Lactic - blood</topic><topic>Acidosis, Lactic - chemically induced</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antiretroviral drugs</topic><topic>Cardiology and cardiovascular system</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 2 - blood</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - drug therapy</topic><topic>Diabetes Mellitus, Type 2 - mortality</topic><topic>Endocrinology and metabolism</topic><topic>Female</topic><topic>Geriatry and gerontology</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Hydrogen-Ion Concentration</topic><topic>Lactic Acid - blood</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Metformin - administration & dosage</topic><topic>Metformin - adverse effects</topic><topic>Metformin - blood</topic><topic>Methodology</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Pathogenesis</topic><topic>Pharmacovigilance</topic><topic>Plasma</topic><topic>Prognosis</topic><topic>Statistics</topic><topic>Survival Analysis</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boucaud-Maitre, D.</creatorcontrib><creatorcontrib>Ropers, J.</creatorcontrib><creatorcontrib>Porokhov, B.</creatorcontrib><creatorcontrib>Altman, J.-J.</creatorcontrib><creatorcontrib>Bouhanick, B.</creatorcontrib><creatorcontrib>Doucet, J.</creatorcontrib><creatorcontrib>Girardin, E.</creatorcontrib><creatorcontrib>Kaloustian, E.</creatorcontrib><creatorcontrib>Lassmann Vague, V.</creatorcontrib><creatorcontrib>Emmerich, J.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Diabetic medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boucaud-Maitre, D.</au><au>Ropers, J.</au><au>Porokhov, B.</au><au>Altman, J.-J.</au><au>Bouhanick, B.</au><au>Doucet, J.</au><au>Girardin, E.</au><au>Kaloustian, E.</au><au>Lassmann Vague, V.</au><au>Emmerich, J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lactic acidosis: relationship between metformin levels, lactate concentration and mortality</atitle><jtitle>Diabetic medicine</jtitle><addtitle>Diabet. Med</addtitle><date>2016-11</date><risdate>2016</risdate><volume>33</volume><issue>11</issue><spage>1536</spage><epage>1543</epage><pages>1536-1543</pages><issn>0742-3071</issn><eissn>1464-5491</eissn><coden>DIMEEV</coden><abstract>Aim
The role of metformin in lactic acidosis is regularly questioned. Arguments against a causal role for metformin in lactic acidosis occurrence are the lack of correlation between plasma metformin and lactate levels, as well as between metformin plasma levels and mortality. We aim to analyse these correlations in a large series of lactic acidosis cases recorded in the French nationwide pharmacovigilance database.
Methods
All cases of lactic acidosis spontaneously reported between 1985 and October 2013 associated with metformin exposure were extracted from the pharmacovigilance database. We assessed the statistical correlations between prescribed daily doses of metformin, plasma concentrations of metformin and lactate, pH and plasma creatinine, as well as the relationship between mortality and these variables.
Results
Seven hundred and twenty‐seven cases of lactic acidosis were reported during the period. Metformin plasma concentration was documented for 260 patients, lactate plasma concentration for 556 patients, pH for 502 patients, creatinine for 397 patients and the vital outcome for 713 patients. Metformin plasma concentration, lactate concentration, pH and plasma creatinine were all correlated (P < 0.001). There were significant differences between surviving and deceased patients in terms of metformin plasma levels (25.2 vs. 37.4 mg/l, P = 0.002) and lactate concentrations (10.8 vs. 16.3 mmol/l, P < 0.001). Thirty per cent of patients died when metformin concentration was > 5 mg/l compared with 11% for patients with concentration < 5 mg/l (P = 0.003).
Conclusions
Our data suggest that metformin accumulation contributes to the pathogenesis and prognosis of lactic acidosis.
What's new?
This paper examines the correlations observed between metformin, lactate plasma and mortality in the largest case series of lactic acidosis available (n = 727).
Significant differences are observed between surviving and deceased patients in terms of metformin plasma levels (25.2 vs. 37.4 mg/l, P = 0.002) and lactate concentrations (10.8 vs. 16.3 mmol/l, P < 0.001).
These findings contradict other publications on this matter and suggest that metformin accumulation might contribute to the pathogenesis and prognosis of lactic acidosis.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>26882092</pmid><doi>10.1111/dme.13098</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0742-3071 |
| ispartof | Diabetic medicine, 2016-11, Vol.33 (11), p.1536-1543 |
| issn | 0742-3071 1464-5491 |
| language | eng |
| recordid | cdi_hal_primary_oai_HAL_hal_02473379v1 |
| source | MEDLINE; Access via Wiley Online Library |
| subjects | Acidosis, Lactic - blood Acidosis, Lactic - chemically induced Adolescent Adult Aged Aged, 80 and over Antiretroviral drugs Cardiology and cardiovascular system Diabetes Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - drug therapy Diabetes Mellitus, Type 2 - mortality Endocrinology and metabolism Female Geriatry and gerontology Human health and pathology Humans Hydrogen-Ion Concentration Lactic Acid - blood Life Sciences Male Metformin - administration & dosage Metformin - adverse effects Metformin - blood Methodology Middle Aged Mortality Pathogenesis Pharmacovigilance Plasma Prognosis Statistics Survival Analysis Young Adult |
| title | Lactic acidosis: relationship between metformin levels, lactate concentration and mortality |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-21T16%3A42%3A34IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_hal_p&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Lactic%20acidosis:%20relationship%20between%20metformin%20levels,%20lactate%20concentration%20and%20mortality&rft.jtitle=Diabetic%20medicine&rft.au=Boucaud-Maitre,%20D.&rft.date=2016-11&rft.volume=33&rft.issue=11&rft.spage=1536&rft.epage=1543&rft.pages=1536-1543&rft.issn=0742-3071&rft.eissn=1464-5491&rft.coden=DIMEEV&rft_id=info:doi/10.1111/dme.13098&rft_dat=%3Cproquest_hal_p%3E1826649999%3C/proquest_hal_p%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1829505932&rft_id=info:pmid/26882092&rfr_iscdi=true |