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.
Author: Language: en-us Episodes: 100

Core EM - Emergency Medicine Podcast
Podcast Episodes
Episode 182.0 – Wellens [not-audio_url] [/not-audio_url]

Duration: 8:04
An interesting back story on this must-not-miss EKG finding in the ED! Hosts: Joseph Offenbacher, MD Audrey Bree Tse, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/CoreEM_Wellens.mp3 Download One Comment…
Episode 181.0: Subarachnoid Hemorrhage [not-audio_url] [/not-audio_url]

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We discuss EM presentation, diagnosis, and management of subarachnoid hemorrhage. Hosts: Mark Iscoe, MD Brian Gilberti, MD Bree Tse, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/SAH.mp3 Download One Com…
Episode 180.0: Urine Tox Screens [not-audio_url] [/not-audio_url]

Duration: 19:40
We discuss the (F)utility(?) of ED Utox screens with our very own Dr. Phil DiSalvo. Hosts: Bree Tse, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Urine_Drug_Screen_final.mp3 Download…
Episode 179.0 – Precipitous Breech Deliveries [not-audio_url] [/not-audio_url]

Duration: 14:07
EM management of the rare but potentially complicated precipitous vaginal breech delivery. Hosts: Audrey Bree Tse, MD Masashi Rotte, MD MPH https://media.blubrry.com/coreem/content.blubrry.com/coreem/Breesashi_Breech_Cor…
Episode 178.0 – Graduation Speech by Dr. Goldfrank [not-audio_url] [/not-audio_url]

Duration: 5:23
The speech given by Dr. Goldfrank at the 2020 NYU / Bellevue Emergency Medicine Graduation Ceremony https://media.blubrry.com/coreem/content.blubrry.com/coreem/Goldfrank_Graduation_Speech_2020.mp3 Download Leave a Commen…
Episode 177.0 – Hemoptysis [not-audio_url] [/not-audio_url]

Duration: 14:26
An overview and management tips of hemoptysis in the ED. Hosts: Brian Gilberti, MD Audrey Bree Tse, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Hemoptysis.mp3 Download One Comment Tags: Critical Care,…
Episode 176.0 – Pneumonia Updates [not-audio_url] [/not-audio_url]

Duration: 10:03
We go over the recent updates in the workup and management of pneumonia. Hosts: Brian Gilberti, MD Audrey Tse, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Pneumonia_Updates.mp3 Download Leave a Comment…
Episode 175.0 – Posterior Circulation Stroke [not-audio_url] [/not-audio_url]

Duration: 15:24
Diagnosing and managing one of our critical diagnoses - posterior stroke. Hosts: Mukul Ramakrishnan, MD Audrey Bree Tse, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/final_posterior_stroke_podcast_post_…
Episode 174.0 – Homelessness [not-audio_url] [/not-audio_url]

Duration: 21:45
We discuss one of the most complex problems we face – Homelessness Hosts: Kelly Doran, MD Audrey Tse, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Homelessness.mp3 Download One Commen…
Episode 173.0 – Blunt Neck Trauma [not-audio_url] [/not-audio_url]

Duration: 12:28
We go into one of the more complex injuries – blunt neck trauma. Hosts: Audrey Bree Tse, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Blunt_Neck_Injuries.mp3 Download One Comment Tags…