UMEM Educational Pearls

Category: Toxicology

Title: Metformin Toxicity - An Emergency Department Diagnosis

Keywords: lactic acidosis, metformin, renal failure (PubMed Search)

Posted: 7/10/2008 by Fermin Barrueto, MD (Updated: 3/26/2023)
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Metformin is the most commonly prescribed oral diabetic mediction in US
Relative contraindication is in renally impaired patients, they are susceptible to the lactic acidosis
Lethal adverse effect is the increase production of lactate
ED patient with an anion gap metabolic acidosis, check for metformin and check the lactate
The lactic acidosis is often severe (>10 mmol/L) and carries a high mortality rate that has been estimated at >40%
Correction of pH and emergent hemodialysis are essential

Perrone et al. Occult metformin Toxicity in Three patients with profound lactic acidosis. J Emerg Med 2008, June 18.