Core EM - Emergency Medicine Podcast

Episode 124.0 – Metformin-Associated Lactic Acidosis

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This week we discuss a quick case leading into the management of MALA.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_124_0_Final_Cut.m4a
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Tags: Metformin, Toxicology
Show Notes

Take Home Points

  • In patients with shortness of breath and clear lungs, consider metabolic acidosis with respiratory alkalis as a potential cause
  • Suspect MALA in any patient on metformin who presents with abdominal pain, nausea and vomiting and/or AMS
  • Patients with MALA will have a low pH, a high-anion gap metabolic acidosis and high lactate levels
  • Call your tox consultant to assist with management which will focus on fluid resuscitation with isotonic bicarbonate and dialysis

    • Read More

    Bosse GM. Antidiabetics and Hypoglycemics. In: Hoffman RS, Howland M, Lewin NA, Nelson LS, Goldfrank LR. eds. Goldfrank’s Toxicologic Emergencies, 10e New York, NY: McGraw-Hill; 2015. Link Accessed October 31, 2017

    LITFL: Metformin-Associated Lactic Acidosis

    LITFL: Metformin

    The Poison Review: 6 Pearls About Metformin and Lactic Acidosis


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