Metformin Associated Lactic Acidosis (MALA) 



Pathophysiology of MALA

 - Metformin interferes with the activity of the Cori cycle, an enzymatic cycle found in the liver that recycles peripheral lactate and converts it into pyruvate & glucose for use in cellular metabolism

 - At concentrations > 5 μg/mL, metformin binds to complexes of the mitochondrial electron transport chain and inhibits hepatocellular aerobic ATP production  increased lactate production via anaerobic metabolism

Diagnosis of MALA

 - Abdominal pain, gastrointestinal distress and acute kidney injury are common at presentation

 - Clinical presentation also includes symptoms of metabolic acidosis including:

   - Kussmaul respiration

   - altered mental status

   - hemodynamic instability



By Dr. Kathryn Watson @Kat_Watson



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