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    A patient with acute renal failure associated with lactic acidosis as a result of concurrent treatment with metformin is described. The risk of renal failure with the use of traditional NSAIDs is well known. However, what is less well appreciated is the role that the COX 2 inhibitors may play in the development of renal failure which, when it occurs in a patient on metformin, can lead to a potentially disastrous outcome. Accepted for publication: July 9, 2003Drug‐related causes of morbidity and mortality are recognized increasingly.1 In recent years, a new class of non‐steroidal anti‐inflammatory drug (NSAIDS), the COX 2 inhibitors, have been developed. They reduce the incidence of gastrointestinal side effects compared with traditional NSAIDs.2 This benefit has made these drugs increasingly attractive, but it should be remembered that this benefit does not extend to the renal system. The following describes a patient with acute renal failure and lactic acidosis as a result of concurrent treatment with metformin. A 58‐yr‐old female presented with a 4‐day history of increasing lethargy, anorexia, abdominal pain, and nausea. Her abdominal pain and nausea became worse on the fifth day and her family sought medical help when her conscious level began to become impaired. Her medical history included 10 years of type 2 diabetes mellitus treated with diet modification and metformin 500 mg bd, and mild osteoarthritis of the knees. Is Metformin A Nephrotoxic? DiabetesTalk. Net propranolol lek Metabolic Effects of Metformin in Patients with Acute Renal Failure New FDA Recommendations for Metformin - Medscape
     
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