Metformin associated lactic acidosis


  • Metformin associated lactic acidosis
Our story starts in a small village nearby Brno, where the married couple Melitovi are going to have dinner. The husband (45 y/o) has been vomiting the last few days and doesn’t have much appetite. His wife worries about him. When Mr. Melita wants to get up from the chair, he suddenly feels nauseous. He is breathing deeply, he is agitated, confused and his head is spinning. Mrs. Melitová doesn’t hesitate and immediately calls the ambulance. The ambulance crew gathers some information about the patient and finds out that he has type 2 DM and is treated with metfromin. Mr Melita is transported to the emergency department. You are the doctor at the emergency department, what should be your next step?

Obtain medical history of the patient, perform physical examination, EKG, send blood to biochemical test, arterial blood gas test + lactic acid, chest X-ray, urinalysis

Correct answer

Gather information from the patient and his wife or from the medical record, perform basic physical examination and blood tests (including ABG sampling) and urine tests (creatinine, glucose, proteins or hematuria). X-ray is fast and gives us a lot of information and helps us with the differential diagnosis (pleural effusion, pulmonary infiltrates).


Obtain medical history of the patient, perform physical examination and call the neurologist.

Wrong answer

The patient wouldn’t thank you, he needs you to stabilise his vital functions, not to evoke his reflexes.


Obtain medical history of the patient, do the physical examination, bronchoscopy, FOBT (fecal occult blood test), head MRI.

Wrong answer

These examinations are ivasive and are indicated after the patient is stabilized, they are second and third-line examinations used in the differential diagnosis. It is important to always start with less invasive types of examination which can help us with differencial diagnosis.




DM - diabetes mellitus ABG test - arterial-blood gas test MRI - magnetic resonance imaging×

40 bpm


100 bpm


95 %


110/60 mmHg


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