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Lactic acidosis from metformin accumulation — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesLactic acidosis from metformin accumulationSCE Acute Medicine

A patient taking metformin develops anuric AKI after gastroenteritis. Lactate is 14 mmol/L, pH 6.92 and shock persists despite resuscitation. What is the most appropriate escalation?

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Correct answer: B — Stop metformin and discuss urgent extracorporeal therapy

The best answer is “Stop metformin and discuss urgent extracorporeal therapy”. This is correct because profound acidaemia, very high lactate, shock and renal failure favour urgent toxin removal and correction of acid–base disturbance. This is not DKA when marked hyperglycaemia and ketonaemia are absent. Oral therapy and delayed confirmation are unsafe, and the causal medicine must be stopped.

Reference: UK Kidney Association acute kidney injury guidance: https://www.nice.org.uk/guidance/ng148/chapter/Recommendations