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The biguanide phenformin was withdrawn from the market of several western countries at the end of seventies because of several cases of lethal lactic acidosis [1]. However, phenformin is still sporadically used in some countries and in immigrant diabetic patients who had this drug previously prescribed. Recently interest for oral biguanides has been renewed, as metformin, reported to induce lactic acidosis very rarely, is widely prescribed for the treatment of noninsulin-dependent diabetes (NIDDM) [1]. Biguanide-induced lactic acidosis is a severe disease with an overall mortality rate of about 50% [1]. Therapeutic approaches consist in respiratory and haemodynamic support and in removing the drug from the circulation. A protocol has been proposed comprising administration of volume expanders, sodium bicarbonate, insulin, dialysis and/or dichloroacetate [1]. In particular, the role of haemodialysis in biguanide-induced lactic acidosis remains controversial. Its effectiveness is a function of the type of drug used, of the amount of drug ingested and of the number of treatments. Whereas metformin and buformin are dialysable, phenformin is poorly eliminated from the body compartments with conventional haemodialysis [2-4]. Continuous venovenous haemofiltration ( C W H ) is a well-defined modality of extracorporeal treatment in critical ill patients with unstable haemodynamic conditions [5]. Previous reports described the treatment of lactic acidosis using haemofiltration [6,7], but to our

Efficacy of continuous venovenous haemofiltration (CVVH) in the treatment of severe phenformin-induced lactic acidosis