Thailand Doctors Slash Deaths in Metformin Emergency Cases with Fast New Protocol
Kittisak Meepoon Fact checked by:Thailand Medical News Team Dec 06, 2025 43 minutes ago
Thailand Doctors: Life Threatening Condition Gets Life Saving Overhaul
Doctors at Maharat Nakhon Ratchasima Hospital in Thailand have unveiled a new emergency treatment protocol that has nearly halved the death rate of patients suffering from a rare but deadly complication of the diabetes drug metformin. Known as Metformin-Associated Lactic Acidosis, or MALA, the condition is caused by a dangerous buildup of lactic acid in the blood. Without quick intervention, MALA can quickly turn fatal.
Thailand doctors reduce deaths from rare metformin emergency with faster dialysis and standardized care
This Medical News report spotlights a landmark study that focused on introducing a fast-track clinical pathway to rapidly diagnose and initiate dialysis for MALA patients. The research team aimed to reduce delays and improve survival, and the results were remarkable.
What the New Protocol Does
The protocol implemented by
Thailand Doctors at Maharat Nakhon Ratchasima Hospital (MNRH) focused on speeding up diagnosis and beginning dialysis treatment as quickly as possible. Patients were treated with different types of dialysis depending on their needs, including intermittent hemodialysis, continuous kidney replacement therapy, or peritoneal dialysis. Another hospital, Buriram Hospital, served as a control site and did not adopt the new system.
In the study, researchers analyzed 347 cases over a five-year period. At MNRH, the 30-day death rate for MALA dropped from 25.7 percent to just 13.9 percent after the new protocol was introduced. Meanwhile, Buriram Hospital showed no such improvement, with mortality hovering around 30 percent. Notably, MNRH’s mortality rate continued to improve each quarter after adopting the new process.
Dialysis Delays Drastically Reduced
One of the key improvements was the dramatic cut in “door-to-dialysis” time—the average time it took to start dialysis after a patient arrived at the hospital. That time fell from 870 minutes to 690 minutes under the new system. In addition, awareness of MALA among hospital staff jumped from 38.5 percent to 89.9 percent, showing that education and training were also key parts of the protocol’s success.
Why Metformin Users Should Be Aware
Metformin is widely prescribed for type 2 diabetes and is generally considered safe. However, MALA can occur in rare situations, especially when patients have kidney or liver problems, severe infections, or other health conditions that limit oxygen in the body. Symptoms of MALA include nausea, fast breathing, confusion, weakness, and in severe cases, low blood pressure or organ failure.
Doctors Call for Widespread Adoption
Dr. Watanyu Parapiboon, lead author of the study, emphasized that time is critical in MALA cases. “A standardized MALA protocol covering diagnosis, access, and treatment shortened door-to-dialysis time, increased awareness, and r
educed care variation,” he explained. He also stressed the importance of making multiple dialysis options available to ensure flexibility in emergency care.
Study Highlights Hope for Global Change
The study provides strong evidence that hospitals can save lives by quickly recognizing MALA and taking swift, standardized action. With millions of people worldwide taking metformin, especially in diabetes-prone populations, more hospitals are likely to consider similar emergency pathways to protect vulnerable patients. Quick action, proper education, and access to dialysis are key to improving survival.
The study findings were published as abstracts presented during the ASN Kidney Week 2025 in the peer reviewed Journal of the American Society of Nephrology.
https://journals.lww.com/jasn/fulltext/2025/10001/reducing_mortality_in_metformin_associated_lactic.168.aspx
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