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Archived Comments for: Metformin-induced lactic acidosis: a case series

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  1. Diabetic acidosis due to D-lactate

    Heikki Savolainen, Dept. of Occup. Safety & Hlth., POB 535, Tampere, FIN-33101, Finland

    30 July 2008

    Lactic acidosis is very common in diabetes and probably caused by methylglyoxal from excessive glucose metabolized in the glyoxalase system to d-lactic acid (1). Metformin seems to increase the d-lactic acid formation.

    D-lactate causes a neurotoxic syndrome by an unknown mechanism. The long metabolic half-life of the acid may contribute to this as its oxidation by the high Km mitochondrial D-lactate oxidase is slow.

    1 Talasniemi JP, Pennanen S, Savolainen H, et al. Analytical investigation: Assay of D-lactate in diabetic plasma and urine. Clin Biochem (2008), doi:10.1016/j.clinbiochem.2008.06.011

    Competing interests