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Metformin Lactic Acidosis HD — ESENeph MCQ

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ModerateAcute Kidney InjuryMetformin Lactic Acidosis HDESENeph

A 42-year-old man develops severe lactic acidosis (lactate 15 mmol/L, pH 6.9, bicarbonate 5 mmol/L) in the context of Metformin 2 g daily and acute gastroenteritis with dehydration. His creatinine has risen from 120 to 480 umol/L. What is the definitive treatment?

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Correct answer: B — Emergency haemodialysis – removes both Metformin and lactate, and corrects acidosis

Metformin-associated lactic acidosis (MALA) with severe acidosis (pH <7.0) and AKI is a life-threatening emergency. Haemodialysis is the definitive treatment: it efficiently removes Metformin (low molecular weight, low protein binding, high volume of distribution eventually cleared by dialysis), corrects acidosis via bicarbonate-containing dialysate, and treats the AKI. EXTRIP (Extracorporeal Treatments in Poisoning) guidelines recommend haemodialysis for severe MALA. IV fluids and bicarbonate are adjunctive but often insufficient alone.

Reference: EXTRIP 2015 – Metformin Poisoning; KDIGO 2012 – AKI