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Metformin-associated lactic acidosis — ESENeph MCQ

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HardAcute Kidney Injury, Electrolytes and Acid-BaseMetformin-associated lactic acidosisESENeph

A 74-year-old man with CKD G4 and type 2 diabetes is brought in with shock after gastroenteritis. He takes metformin and an ACE inhibitor; lactate is 11 mmol/L, pH 7.04, bicarbonate 8 mmol/L and creatinine 482 micromol/L. He remains oliguric despite resuscitation and vasopressor support. What is the most appropriate renal replacement modality?

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Correct answer: A — Continuous renal replacement therapy in critical care

Severe lactic acidosis with haemodynamic instability and oliguric AKI is best managed with critical care support and continuous renal replacement therapy when dialysis is required. Outpatient or delayed intermittent dialysis is inappropriate in shock. Peritoneal dialysis is too slow for this acute metabolic emergency in an unstable adult. The pearl is that metformin-associated lactic acidosis is managed by stopping metformin, resuscitation and extracorporeal clearance when severe.

Reference: https://guidelines.ukkidney.org