ICU SAQs · Renal / acid-base
Metformin-associated lactic acidosis — recognition and management
A CICM SAQ on metformin-associated lactic acidosis — recognition, mechanism, extracorporeal removal criteria and the bicarbonate question.
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Prompt
A 70-year-old with type 2 diabetes on metformin presents with vomiting and confusion. pH 7.10, bicarbonate 8 mmol/L, anion gap 28, lactate 14 mmol/L, creatinine 320 micromol/L. Discuss the diagnosis and management.
Question
A 70-year-old with type 2 diabetes on metformin presents with vomiting and confusion. pH 7.10, bicarbonate 8 mmol/L, anion gap 28, lactate 14 mmol/L, creatinine 320 micromol/L. Discuss the diagnosis and management.[1]
References6ShowHide
- [1]See KC Metformin-associated lactic acidosis: A mini review of pathophysiology, diagnosis and management in critically ill patients. World journal of diabetes, 2024.PMID 38983827
- [2]Calello DP, Liu KD, Wiegand TJ, et al. Extracorporeal Treatment for Metformin Poisoning: Systematic Review and Recommendations From the Extracorporeal Treatments in Poisoning Workgroup. Critical care medicine, 2015.PMID 25860205
- [3]Salpeter SR, Greyber E, Pasternak GA, et al. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. The Cochrane database of systematic reviews, 2010.PMID 20091535
- [4]Kamel KS, Oh MS, Halperin ML L-lactic acidosis: pathophysiology, classification, and causes; emphasis on biochemical and metabolic basis. Kidney international, 2020.PMID 31784049
- [5]Jaber S, Paugam C, Futier E, et al. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet (London, England), 2018.PMID 29910040
- [6]Suetrong B, Walley KR Lactic Acidosis in Sepsis: It's Not All Anaerobic: Implications for Diagnosis and Management. Chest, 2016.PMID 26378980