Summary
In three groups of healthy subjects (n = 56) changes in blood lactate, pyruvate and bicarbonate concentrations and pH were determined during three different loading tests. These were an oral ethanol load (0.5 g/kg body wt), an IV fructose load (1 g/kg body wt over 60 min), and a 15 min submaximal exercise load. The same tests were repeated after administration of biguanides for 3 days in the following doses: phenformin 150 mg, buformin 300 mg and metformin 2.55 g daily. All three derivatives induced a significant rise in blood lactate level as well as a significant increase in blood [lactate]/[pyruvate] ratio in relation to control tests. The differences in the effect of individual biguanides were minimal. It was observed, on the other hand, that increments in blood lactate concentrations depended markedly on the type of load given. The highest rise in blood lactate level was found after fructose loading; in the 60th minute of the test after phenformin it was 1.60±1.29 (SD), after buformin 1.32±0.79, and after metformin 1.31±0.64 mmol/1. The smallest rise of lactate was observed after oral ethanol loading: in the 1st hour of the test the respective values were 0.41±0.24, 0.52 ±0.18, and 0.91±0.86 mmol/1. In the exercise test the highest increment of the blood lactate level was observed 15 min after the end of the exercise, being 1.06±0.37, 1.21±0.25 and 1.26±0.33 mmol/1, respectively. The results of these investigations show that all three biguanide derivatives used in treatment of diabetes — phenformin, buformin and metformin — are risk factors which may induce lactic acidosis under suitable conditions.
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Czyżyk, A., Lao, B., Bartosiewicz, W. et al. The effect of short-term administration of antidiabetic biguanide derivatives on the blood lactate levels in healthy subjects. Diabetologia 14, 89–94 (1978). https://doi.org/10.1007/BF01263445
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DOI: https://doi.org/10.1007/BF01263445