Acidose lactique et metformine

Metformin represents the oral treatment of choice in the treatment of type II diabetes in the absence of contraindications, is started along with the hygieno-dietetic measures at the moment of the diagnosis.
It acts by enhancing the sensitivity to insulin by a decrease in the hepatic glucose production and an increase in its peripheral use. The incidence of metformin-associated lactic acidosis is very low when appropriate rules for prescribing and contra-indications are respected.
The aim of this article is to highlight the pathophysiological mechanisms leading to biguanideassociated lactic acidosis, to better diagnose this condition for a better treatment. We present the case of a 65 years old woman brought in the emergency department in a coma state. The diagnosis and treatment of this coma state confirmed the suspicion we had of a metformin intoxication induced coma. The dosage of metformin for confirmation was possible in a foreign laboratory. Metformin seems to be responsible for lactic acidosis because of self-poisoning or not in the case of an underlying organ failure which induces a lactic acidosis.
Symptomatic treatment and renal replacement therapy which allows metformin removal are the curative treatment. Prevention means correct administration of metformin and also respecting the contraindications.