Episode 124.0 – Metformin-Associated Lactic Acidosis

Episode 124.0 – Metformin-Associated Lactic Acidosis

Author: Core EM December 4, 2017 Duration: 5:51

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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There’s a particular kind of pressure that comes with working in an emergency department, where decisions need to be both swift and sound. Core EM-Emergency Medicine Podcast exists in that space, offering a direct line to the essential knowledge and clinical reasoning that emergency medicine demands. Created by the team at Core EM, each episode feels less like a formal lecture and more like a focused conversation with a trusted colleague. You’ll hear discussions that break down critical topics, from managing common presentations to unraveling complex, high-acuity cases, all grounded in current evidence and practical reality. This podcast serves as a reliable resource for physicians, residents, and advanced practice providers looking to solidify their foundation or stay sharp on the latest evidence. It’s about cutting through the noise to deliver core content that’s immediately applicable at the bedside. Tune in for a clear, concise, and always relevant dive into the principles that define emergency care, designed to fit into a busy clinician’s life between shifts or during a commute.
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Core EM - Emergency Medicine Podcast
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