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Posts Tagged ‘contrast induced nephropathy and metformin usage’

Metformin is one of most commonly used oral hypoglycemic drug listed by WHO as an essential anti diabetic drug. .It is a biguanide  which  blocks the hepatic gluoneogenesis . Since lactate is the major substrate for the process of gluco-neogenesis , excess of which  spills into blood .Lactate is swiftly cleared by the normally functioning  kidneys .Metformin is completely excreted by the kidney. Hence in patients  with compromised renal function (or when  contrast agents compete with Metformin in renal excretion ) high levels would not only cause lactic acidosis (> 5meq), it can also aggravate contrast induced renal injury resulting in a downward hepato -reno-metabolic spiral.

Though the incidence of Metformin induced Lactic acidoss  is low , the outcome can be bad , hence the concern. The European society of urogenital radiology  has provided clear cut guidelines regarding Metformin usage when contrast agents are being used.

metformin and contrast induced nephropathy guidelines cin european

What can be done in emergency situations 

  • Since the risk  of  lactic acidosis is very low , in case of emergency situations Metformin need not be discontinued prior to contrast usage.However it need to be stopped for 48 hours from the index procedure. (Fortunately Metformin is a dialysible drug that can be removed in case of toxic accumulation.)
  • Consider alternate mode of Imaging if renal function is really concerning

 

Reference

1.Pre admission metformin use and mortality among intensive care patients with diabetes: a cohort study.Christiansen C, Johansen M, Christensen SCrit Care. 2013 Sep 9;17(5):R192. doi: 10.1186/cc12886

2. http://ccforum.com/content/pdf/cc12886.pdf

contrast nephropathy

A good  article  from drug review Contrast induced nephropathy and metformin

 

 

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