To the Editor:-Mercker et al. [1]reported a case of severe biguanide-induced lactic acidosis. However, the authors did not discuss specific therapies. In such case, the administration of sodium dichloroacetate (DCA) should have been considered. DCA is an antidiabetic agent that activates the pyruvate dehydrogenase complex, the mitochondrial enzyme that catalyzes the conversion of pyruvate to acetyl-coenzyme A and carbon dioxide. In dogs DCA has been reported to correct lactic acidosis induced by phenformin, another biguanide that induces lactic acidosis more commonly. [2]In the patient described, an ongoing infection could have contributed to the overproduction of lactate. Even in endotoxin-induced lactic acidosis, DCA administration has been shown to reduce blood lactate levels. [3,4]Administration of DCA could reduce plasma lactate levels in patients with lactic acidosis caused by various etiologies, even though in a large clinical trial, such intervention did not improve survival rates. [5] 

Jean-Charles Preiser, M.D.

Jean-Louis Vincent, M.D., Ph.D.

Department of Intensive Care; Erasme University Hospital; Route de Lennik 808; B-1070 Brussels; Belgium

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