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Septic shock requiring vasopressors — SCE Acute Medicine MCQ

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HardCritical Care MedicineSeptic shock requiring vasopressorsSCE Acute Medicine

A 58-year-old man taking metformin presents with shock and oliguric AKI. Arterial pH is 6.92, lactate 19 mmol/L and creatinine 620 micromol/L despite resuscitation; sepsis and tissue ischaemia are being treated and excluded in parallel. What additional treatment is most appropriate?

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Correct answer: E — Start high-efficiency haemodialysis with haemodynamic support

Severe metformin-associated lactic acidosis with profound acidaemia, very high lactate, shock and renal failure warrants urgent extracorporeal treatment. Intermittent haemodialysis efficiently clears metformin and lactate and corrects acidosis; continuous therapy is used when intermittent dialysis cannot be tolerated. Other causes of lactic acidosis still require active treatment.

Reference: https://www.extrip-workgroup.org/metformin