3. Metformin-associated lactic acidosis

The most likely cause of the acidosis in this situation is metformin-induced lactic acidosis (1). The patient was intubated for respiratory failure secondary to severe non-compensated metabolic acidosis and shortly thereafter was started on maximal pressor support with norepinephrine, vasopressin, epinephrine and phenylephrine. Continuous renal-replacement therapy and a sodium acetate drip (chosen due to a hospital and nation-wide bicarbonate shortage) were initiated for the acidosis.

How does sodium acetate improve metabolic acidosis? (Click on the correct answer to proceed to the third of four pages)

  1. Converted in the liver to bicarbonate ion
  2. Enhanced renal reabsorption of bicarbonate
  3. Through enhanced chloride excretion
  4. Trapping hydrogen ion

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