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